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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415464
Report Date: 07/11/2024
Date Signed: 07/15/2024 09:35:43 AM

Document Has Been Signed on 07/15/2024 09:35 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PACIFIC GROVE ADULT EDUCATION CDCFACILITY NUMBER:
274415464
ADMINISTRATOR/
DIRECTOR:		BARBARA MARTINEZFACILITY TYPE:
850
ADDRESS:1025 LIGHTHOUSE AVENUETELEPHONE:
8316466623
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 19DATE:
07/11/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Jennifer HallTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Andrea Cortez conducted an unannounced Annual Required Inspection at Pacific Grove adult education CDC to ensure compliance with the Title 22 California Code of Regulations. LPA was greeted and granted access by Qualified Teacher/Director Jennifer Hall Administrator Barbara Martinez is on vacation. LPA explained the nature of the inspection and thoroughly toured both inside and outside of the facility. LPA observed the required posted materials: Facility License, Menus, PUB 269 Child Passenger Restraint System Poster, PUB 393 Notification of Parents Rights, LIC 610 Emergency Disaster Plan, LIC 9148 Earthquake Preparedness Checklist, LIC 613A Personal Rights, and Activity Schedule.

LPA reviewed 6 children's records. Ensuring that each file contains: Personal Rights, Admission Agreement, Identification and Emergency Information, Physicians Report, Notification of Parents Rights, Consent for Emergency Medical Treatment, and Immunization's. In conjunction, LPA audited 6 Personnel Records for each present staff member. Each file contained transcripts/verification of experience, Current Pediatric CPR & First Aid Certifications, Immunization, Health Screening Report, Criminal Record Statement, Statement Acknowledging Requirement to Report Child Abuse, Employee Rights, and Keenan issued Mandated Reporter Certificate.

LPA noted: Jennifer Hall has a valid Child Development Program Director Permit issued by California Commission on Teacher Credentialing

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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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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 ADULT EDUCATION CDC
FACILITY NUMBER: 274415464
VISIT DATE: 07/11/2024
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LPA advised on capacity ratios at which time LPA emphasized on section 101229(a)(1) of Title 22 Responsibility for Providing Care and Supervision regulation. LPA observed all classrooms to be clean and in order, with drinking water readily available via water bottles. LPA observed solid waste containers with tight-fitting lids in each room, and the staff and children's bathrooms were found to be clean and sanitary. LPA noted separate staff bathroom that are not utilized by the children.

No weapons or firearms on the premises was confirmed.

LPA observed food preparation and storage areas were found to be clean and free of litter, rubbish, rodents, and other vermin. Additionally, cleaning supplies were securely stored in top cabinets inaccessible to children. Qualified Teacher Jennifer Hall stated that lunches and snacks are brought from home. However, snacks and/or lunches are offered.

LPA observed that a fully charged 2A10BC fire extinguisher and working smoke/carbon monoxide detectors are in place. Qualified teacher/Director Jennifer Hall stated at this time facility no medications are administer.

LPA did not observe any bodies of water. However, water tables are used for play time. LPA gave “Drowning Is Silent” flyer that includes Water Safety Tips and informational website address.

LPA advised individuals who require caregiver background checks. Have received criminal record and child abuse index clearances or exemptions before working with children in care. In conjunction, LPA went over applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who encounter or provide care and supervision to the children. A $500 immediate civil penalty. An ongoing $100 per day per violation continues until the violation(s) is corrected.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
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 ADULT EDUCATION CDC
FACILITY NUMBER: 274415464
VISIT DATE: 07/11/2024
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LPA noted: section 101170 Criminal Record Clearance (H)(I) of Title 22. Staff members have clearances through Pacific Grove Unified School District (PGUSD). Clearances for individuals at this facility who require caregiver background checks are issued by State Department and/or County Office of Education and do not come under the jurisdiction of Community Care Licensing Division.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

No deficiencies cited, exit interview conducted, and a copy of this report was left at the facility.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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