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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214919
Report Date: 09/22/2021
Date Signed: 09/22/2021 03:30:15 PM

Document Has Been Signed on 09/22/2021 03:30 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:VUSD - PACIFIC HIGH JUMPSTART STATE PRESCHOOLFACILITY NUMBER:
566214919
ADMINISTRATOR:LORETTA GALAVIZFACILITY TYPE:
850
ADDRESS:501 COLLEGE DRIVETELEPHONE:
(805) 641-5000
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 16TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/22/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Andrea StegmanTIME COMPLETED:
03:35 PM
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At 2:25 PM, a case management inspection was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and C. Patterson who met with Andrea Stegman in regards to a increase of capacity from 16 children to 28 children. The preschool program is located on the premises of Pacific High School in two classrooms #4 and #5. LPAs observed the center to be clean, orderly and appropriately furnished indoors and outdoors for young children.

In regards to the increase of capacity LPAs measured and re-evaluated classrooms #4 and #5 for the increase of capacity.

Indoor square feet exceeds the requirement needs for 28 preschoolers.
Outdoor square footage exceeds the requirement for 28 preschoolers.
2 Toilets and 4+ Urinals exceeds the requirement for 285 children.
5+ sinks exceeds the requirement for 28 preschoolers.
Water is available indoor and outdoors.
Shade was observed to be available.

Fire Clearance was granted on 09/08/2021.

Prior to licensure of the increase a capacity submit the following:
1. Verification from the school district they are approved to utilize both restrooms.
2. Waiver to allow the preschool to utilize the restroom used by another preschool program.

Failure to Post the Notice of Site Visit for 30 days for review.
Ana Tolentino
Sylvia Mendoza-Ceja
DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2021
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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