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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274413124
Report Date: 02/04/2026
Date Signed: 02/04/2026 01:56:12 PM

Document Has Been Signed on 02/04/2026 01:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PACIFIC GROVE UNIFIED SCHOOL DIST./STATE PRESCHOOLFACILITY NUMBER:
274413124
ADMINISTRATOR/
DIRECTOR:		DIANE M. BERONFACILITY TYPE:
850
ADDRESS:1004 DAVID AVENUETELEPHONE:
(831) 646-6547
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: DATE:
02/04/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:07 AM
MET WITH:Abbie ArbrunTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On February 4, 2026, Licensing Program Analyst (LPA ) Darnella Barnes and Analyst II Joe Macias conducted an unannounced annual inspection. The purpose of the visit was explained to Director Abbie Arbrun, who granted access and received the Entrance Checklist (LIC 125). At the time of inspection, Director, Principal Director, Superintendent, Director of Facilities, 3 staff and fifteen children were present.

The facility operated Monday through Friday from 8:55 a.m. to 1:55 p.m. Meals were provided by the Pacific Grove Unified School District Nutrition Department and delivered daily. Breakfast, am snack, and lunch were provided. Water bottles were available for children.

All required postings were visible. The most recent fire drill was conducted on 1/26/26. LPA AND ANALYST II reminded the Director of the six-month fire drill requirement and documentation. Fire extinguisher rated 3A-40-BC was present last serviced on June 5, 2025. Working built fire detection system, carbon monoxides and telephone were present. The Director stated there were no firearms on the premises and that smoking was prohibited.

Fingerprint clearances for individuals requiring caregiver background checks were obtained through the State Department and/or County Office of Education and were not under the jurisdiction of the Community Care Licensing Division.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 02/04/2026 01:56 PM - It Cannot Be Edited


Created By: Darnella Barnes On 02/04/2026 at 01:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PACIFIC GROVE UNIFIED SCHOOL DIST./STATE PRESCHOOL
FACILITY NUMBER: 274413124

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Four staff members missing pertussis, measles and flu or declinaiton of flu immunizations.
POC Due Date: 02/25/2026
Plan of Correction
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The director will provide documentation of missing immunizations for four staff members by the due date to LPA. The director will also submit a plan of correction outlining how this issue will be prevented in the future
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Four staff members have missing personnel documentation.
POC Due Date: 02/25/2026
Plan of Correction
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The director will provide documentation of personnel documents for four taff members by the due date. The director will also submit a plan of correction outlining how this issue will be prevented in the future
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Darnella Barnes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2026


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PACIFIC GROVE UNIFIED SCHOOL DIST./STATE PRESCHOOL
FACILITY NUMBER: 274413124
VISIT DATE: 02/04/2026
NARRATIVE
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The indoor environment was clean and maintained. Flooring was intact and free of hazards. Toy containers had smooth edges and secure lids. Each child had a labeled storage space. Cots were constructed of wipeable materials. Bedding and coverings were washed weekly or as needed.

Bathroom facilities met the required ratio of one sink and one toilet per fifteen children. Floors were mopped and carpets vacuumed and toileting areas were cleaned daily by janitorial services. Trash was stored in covered containers. Indoor temperatures measured 68 degrees Fahrenheit in all rooms.

A review of five children’s files was conducted, and all files were found to be complete.

Sign-in and sign-out records were completed and were reviewed. Records contained full legal signatures and accurate times.

A review of five staff files was conducted, and all files were complete with the exception of missing immunizations measles, pertussis and flu and other personnel documents for several staff therefore two type Citation B’s on attached LIC809D. Director was reminded that Mandated Reporter Training and CPR/First Aid certification must be renewed every two years, and that at least one staff member must always maintain current CPR and First Aid certification. The Director was also reminded that aides and assistants must remain under the supervision of a qualified teacher, except during naptime or bathroom transitions

During the outdoor inspection, walkways, ramps, and stairs were free of hazards. The play area had shade and was set up to allow for safe play. The outdoor area was fenced at least five feet high, free of debris, and contained no accessible hazards or bodies of water.

First aid supplies were observed in a location accessible to staff and inaccessible to children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/. ----CONTINUED NEXT PAGE ------


NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PACIFIC GROVE UNIFIED SCHOOL DIST./STATE PRESCHOOL
FACILITY NUMBER: 274413124
VISIT DATE: 02/04/2026
NARRATIVE
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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the Director shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Classroom sinks were used for handwashing and cleaning only. Water bottles are purchased and used. .

Director was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California..

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please inspection the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During today’s inspection, two “Type B” deficiencies are issued on attached 809-D. Appeal rights provided.


Exit interview was conducted, and the report was reviewed with Director Abbie Aubrun.

------END OF REPORT -----

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026
LIC809 (FAS) - (06/04)
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