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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701507
Report Date: 01/03/2022
Date Signed: 01/03/2022 11:53:48 AM

Document Has Been Signed on 01/03/2022 11:53 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: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: 21TOTAL ENROLLED CHILDREN: 21CENSUS: 0DATE:
01/03/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH: Letitia AriasTIME COMPLETED:
11:00 AM
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On 01/03/22 at 10:48 a.m., Licensing Program Analyst (LPA), Rajani Goudreau arrived at the facility to conduct a pre-licensing inspection to review the slide on the play structure and to deliver an amended report originally created on 12/31/21. Upon arrival LPA, met with Licensee Representative, Letitia Arias and director, and proceeded to tour the facility.

LPA reviewed the play structure slide to be fixed free and free of loose or pointed parts. First aid kit reviewed and complete with the required supplies. Also, plan of operation for the transition of the children to and from the restroom and designated toilet stall for ill children reviewed and approved.

The following is pending with a due date of January 04, 2022:
  • Documentation of the play structure being suitable for ages 2 through 6 years old.

An exit interview was conducted with Licensee Representative, Letitia Arias. The following reports were discussed and provided: LIC809 and Appeal Rights (LIC9058). Once pending documents are received and after final file review, a license will be issued for 20 Preschool children; ages 2 through 6 in preschool classroom #1.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2022
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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