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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701507
Report Date: 06/02/2023
Date Signed: 06/02/2023 02:10:32 PM

Document Has Been Signed on 06/02/2023 02:10 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JUMP PRESCHOOL INC.FACILITY NUMBER:
376701507
ADMINISTRATOR:JACQUELYN AGUIGUI-FAJARDOFACILITY TYPE:
850
ADDRESS:2705 VIA ORANGE WAY, SUITE ATELEPHONE:
(619) 303-1541
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91978
CAPACITY: 50TOTAL ENROLLED CHILDREN: 32CENSUS: 20DATE:
06/02/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lauren WynglarzTIME COMPLETED:
12:30 PM
NARRATIVE
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On 06/02/2023 at 11:30am Licensing Program Analysts (LPAs), David Miller and Martha Malane conducted an unannounced case management deficiency inspection. Upon arrival, LPAs met with Director, Lauren Wynglarz and disclosed purpose of the inspection.

Per observation and interview, eight (8) out of 26 sleeping mats had foam that was exposed and thus were not being kept in a safe condition. See LIC809D for Type B deficiency cited.

LPAs provided Director, Lauren Wynglarz with the Notice of Site Visit – LIC 9213, which is to be posted for thirty (30) days. LPAs observed form LIC 9213 posted on the office window at the entrance. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted with the Director, who was provided a copy of their Licensee Appeal Rights LIC 9058.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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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Document Has Been Signed on 06/02/2023 02:10 PM - It Cannot Be Edited


Created By: David Miller On 06/02/2023 at 11:31 AM
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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: JUMP PRESCHOOL INC.
FACILITY NUMBER: 376701507

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/02/2023
Section Cited
CCR
101239.1(b)(5)

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101239.1(b)(5) Floor mats used for napping shall be maintained in a safe condition with no exposed foam. This requirement is not met as evidenced by:

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The Director removed the mats with exposed foam during the inspection. The Director stated that staff will check for rips and tears daily when mats are sanitized to ensure the sleeping mats meet regulation
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Based on observation and interviews, the licensee did not comply with the section cited above in that 8 out of 26 sleeping mats had foam that is exposed to children, which poses a potential Health and Safety and Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tulam Vu
LICENSING EVALUATOR NAME:David Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2023


LIC809 (FAS) - (06/04)
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