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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364817503
Report Date: 03/24/2023
Date Signed: 03/24/2023 03:18:46 PM

Document Has Been Signed on 03/24/2023 03:18 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:JUMPSTART LEARNING CENTER, INC.FACILITY NUMBER:
364817503
ADMINISTRATOR:MIREYA GOMEZFACILITY TYPE:
850
ADDRESS:10213 BASELINE ROADTELEPHONE:
(909) 373-1831
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 81TOTAL ENROLLED CHILDREN: 81CENSUS: 8DATE:
03/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Mureya Gomez/Director TIME COMPLETED:
03:30 PM
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On 3/24/23 at 3:30 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a case management -incident investigation. LPA met with director was granted access into the facility, toured facility and took a census. LPA interviewed children and staff.

On 3/9/23 it was self reported by director a child fell and hit his head on the wall. Child stated later another child hit the child. LPA interviewed children and staff. Based on interviews conducted LPA has determined there has been no violation of Title 22 regulations.


Exit interview conducted with director, appeal rights and notice of site visit issued.


Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
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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