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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600627
Report Date: 10/14/2021
Date Signed: 10/14/2021 11:37:32 AM

Document Has Been Signed on 10/14/2021 11:37 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JEFF & DENI JACOBS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376600627
ADMINISTRATOR:ANNE PATZOLDFACILITY TYPE:
850
ADDRESS:2360 EAST JEWETT STREETTELEPHONE:
(858) 278-2571
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: 71DATE:
10/14/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Anne PatzoldTIME COMPLETED:
11:50 AM
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On 10/14/2021 @ 10:55AM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced inspection in reference to facility's self-reported incident that happened on 10/6/21 involving a child who touched another child inappropriately. LPA met and toured the classrooms with Anne Patzold, Site Director. Observed present today were 71 preschool children in the following rooms:

Penguins with 9 children and staff Amanda Master, Rahma Hassan & Sally Baez.
Puffins with 10 children and staff Suong Le, Theresa Rodriguez & Maria del Carmen Mijares.
Seals with 15 children and staff Maritza Ariaga, Jocelyn Rangel & Sabrina Phouthakesone.
Dolphins with 11 children and staff Stephanie Figueroa, Amanda Loiurio & Rosa Mejia.
Marlins with 13 children and staff Stephanie Villareal & Marisa Pacheco.
Manatee with 13 children and staff Alexa Aguilar, Laura Velasco and Denise Reyes.

A review of staff records today indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances.

NO DEFICIENCY CITED TODAY.
Exit interview was conducted with Ann Patzold. Appeal rights were discussed. A copy of the appeal rights and licensing report were provided today. Notice of Site Visit was observed posted. Notice shall remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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