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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105084
Report Date: 09/19/2022
Date Signed: 09/19/2022 05:15:21 PM

Document Has Been Signed on 09/19/2022 05:15 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:LEARNING JUNGLE MISSION VALLEYFACILITY NUMBER:
376105084
ADMINISTRATOR:KENDRA DEGROOTFACILITY TYPE:
850
ADDRESS:403 CAMINO DEL RIO SOUTHTELEPHONE:
(619) 309-3430
CITY:SAN DIEGOSTATE: CAZIP CODE:
92108
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 38DATE:
09/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Dolores GuadarramaTIME COMPLETED:
05:15 PM
NARRATIVE
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On 9/19/22 at 2:45 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management visit in regards to an incident that occurred on 8/30/22. Upon arrival, LPA met with Director Dolores Guadarrama. LPA toured the facility with Assistant Director Shyneaqua Woods. Census was 38 children in 3 classrooms with 6 staff members. Three of the staff members were fingerprint cleared but not associated to the facility.

The incident LPA was following up on was in regards to a child receiving the wrong medication that was the result of staff mis-communication. One of the children (C1) was taking medication the previous week and the father had called Assistant Director Shyneaqua Woods that his child (C1) no longer needed medication on Friday 8/26/22. C1 was the only one in the facility with refrigerated medication that week. The Assistant Director failed to communicate this to the staff. The following week on 8/30/22, another child (C2) started a medication. The Director (who had just started at the facility on 8/29/22) did notice that the name on the medication didn't match, but was told the by staff that C1 needed the medication when it was for another child and went ahead and gave C1 the medication that was for C2. Director did not confirm name with roster of children. Director became aware of the mistake when C2's mother called to verify her child received the medication. Director contacted C1's father who confirmed that his child no longer needed medication and verified with the doctor that child would be okay. Director stated the incident was a staff communication error.

LPA Keturah Lane informed facility representative Director Dolores Guadarrama that this report dated 9/19/22 documents 1 Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

(continued on LIC809-C...)

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2022
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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Document Has Been Signed on 09/19/2022 05:15 PM - It Cannot Be Edited


Created By: Keturah Lane On 09/19/2022 at 04:26 PM
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: LEARNING JUNGLE MISSION VALLEY
FACILITY NUMBER: 376105084

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/20/2022
Section Cited
CCR
101223(a)(2)

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101223 Personal Rights - (a) The licensee shall ensure that each child is accorded the following personal rights: (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by...
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Director stated she would ensure that all child medications are communicated to all facility staff by posting name, picture of child and dates of medication where medications are kept and also in each classroom. Director will send an example of posting to LPA Lane via e-mail by 9/20/22.
Keturah.Lane@dss.ca.gov
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Based upon incident report and Director interview, C1 was accidentally given medication meant for C2 and Director did not confirm name of child to label on medication which is an immediate health, safety and personal rights risk to children 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:Monica Cuddy
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/19/2022 05:15 PM - It Cannot Be Edited


Created By: Keturah Lane On 09/19/2022 at 04:32 PM
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: LEARNING JUNGLE MISSION VALLEY
FACILITY NUMBER: 376105084

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2022
Section Cited
CCR
101170(e)(2)

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101170 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not met as evidenced by...
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Director Dolores Guadarrama stated she would associate the three substitutes to Guardian by 9/20/22 and send LPA Lane proof of the association by e-mailing roster from Guardian to: Keturah.Lane@dss.ca.gov
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Based upon record review, three long-term substitutes were not associated to the facility which is a potential health, safety and personal rights risk to children 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:Monica Cuddy
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022


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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LEARNING JUNGLE MISSION VALLEY
FACILITY NUMBER: 376105084
VISIT DATE: 09/19/2022
NARRATIVE
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Also, LPA Lane informed facility representative to provide a copy of this licensing report dated 9/19/22 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Civil penalties were assessed in the amount of $300. Licensee was provided a copy of Civil Penalties Assessment LIC421BG.


See LIC809D for Type A (1) and Type B (1) citations.

Exit interview conducted and report was reviewed with the facility representative Director Dolores Guadarrama. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
LIC809 (FAS) - (06/04)
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