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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105084
Report Date: 11/06/2023
Date Signed: 11/06/2023 01:54:06 PM

Document Has Been Signed on 11/06/2023 01:54 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:LEARNING JUNGLE MISSION VALLEYFACILITY NUMBER:
376105084
ADMINISTRATOR:DOLORES GUADARRAMAFACILITY TYPE:
850
ADDRESS:403 CAMINO DEL RIO SOUTHTELEPHONE:
(619) 309-3430
CITY:SAN DIEGOSTATE: CAZIP CODE:
92108
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 32DATE:
11/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Dolores GuadarramaTIME COMPLETED:
01:30 PM
NARRATIVE
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On 11/6/23 at 12:15 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management visit to follow up on an unusual incident that occurred on 10/30/23. Upon arrival LPA met with Director Dolores (Liz) Guadarrama and toured the facility. Census was during naptime as follows:
  • Room #1 had 9 children with staff members Vanessa Torres-Valencia and Amber Smith
  • Room #2 had 11 children with staff members Mary Kun-Kuy and Vanessa Marrujo
  • Room #3 had 12 children with staff members Angelica (Norma) Delgado, Christina Martinez and Jackie Macias

The unusual incident was reported by the facility on 10/31/23 involved a child who tripped on his own feet, fell and then hit his head on a brick ledge along the wall. The brick ledge is part of a pillar in the classroom that was accessible and not covered. Child sustained an injury and was taken to urgent care. Director stated that the brick pillars will be covered or made inaccessible within 24 hours. See LIC809-D for Type A deficiency cited.

LPA Keturah Lane informed facility representative Director Dolores (Liz) Guadarrama that this report dated 11/6/23 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: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LEARNING JUNGLE MISSION VALLEY
FACILITY NUMBER: 376105084
VISIT DATE: 11/06/2023
NARRATIVE
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Also, LPA Keturah Lane informed facility representative to provide a copy of this licensing report dated 11/6/23 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.

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

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/06/2023 01:54 PM - It Cannot Be Edited


Created By: Keturah Lane On 11/06/2023 at 01:30 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: 11/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/06/2023
Section Cited
CCR
101238(b)(1)

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101238 Buildings and Grounds (b)All children shall be protected against hazards within the center through provision of the following:
(1) Protective devices including but not limited to nonslip material on rugs. This requirement was not met as evidenced by...
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Director stated there are several brick pillars in multiple classrooms that will all be covered with a bumber guard edge protectors by EOB 11/7/23. Director will send a picture of the correction via e-mail to LPA Lane by 11/7/23.
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Based upon LPA observation and facility unusual incident report - a brick pillar in the classroom was accessible and not covered causing injury to a child that fell and hit head on the ledge 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:Tashima Daniel
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2023


LIC809 (FAS) - (06/04)
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