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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701504
Report Date: 05/10/2022
Date Signed: 05/10/2022 05:37:00 PM

Document Has Been Signed on 05/10/2022 05:37 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 RANCHO SAN DIEGO - INFANTFACILITY NUMBER:
376701504
ADMINISTRATOR:TINA PROWANTFACILITY TYPE:
830
ADDRESS:3605 AVOCADO BOULEVARDTELEPHONE:
(619) 569-7607
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 29DATE:
05/10/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Tina Prowant, Facility DirectorTIME COMPLETED:
05:30 PM
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On May 10, 2022, at 4:00 PM, Licensing Program Analyst (LPA), Marie Hernandez, conducted an unannounced Case Management Inspection due to an incident with child #1. On 05/02/2022, the Department received the incident report from the facility for child #1. LPA met with the facility director, Tina Prowant. Through the course of the incident review, LPA conducted several interviews with the staff and the Director. The child could not be interviewed as child is non-verbal.

The facility reported that on 04/27/2022 at 10:27 AM, child #1 was trying to sit on the stool outside in the toddler play yard when child lost her balance and fell forward. The staff stated she observed child #1 trying to sit on a stool but lost her balance. The child's nose bled but staff stated there was no visible injury to child's nose. The staff applied an ice pack to child's nose. The child bled from the nose and started to close her eyes. The parent was contacted immediately and took child to the doctors. The Director stated the parent advised her that child #1 was doing fine with no further incident. The staff stated she observed child #1 lose her balance and fall. LPA inspected the play yard for safety hazards and did not observe any at time of visit. The staff was proactive by tending to child’s needs. The incident is deemed an accident. This concludes the incident review.

An exit interview was conducted and the report was provided to the facility director, Tina Prowant. The Notice of Site Visit was provided and posted by the Facility Director.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2022
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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