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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701505
Report Date: 01/03/2024
Date Signed: 01/03/2024 05:09:12 PM

Document Has Been Signed on 01/03/2024 05:09 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 ADAMS AVENUE - PRESCHOOLFACILITY NUMBER:
376701505
ADMINISTRATOR:XAVIER DEANFRASIOFACILITY TYPE:
850
ADDRESS:3844 ADAMS AVENUETELEPHONE:
(619) 301-7025
CITY:SAN DIEGOSTATE: CAZIP CODE:
92116
CAPACITY: 44TOTAL ENROLLED CHILDREN: 56CENSUS: 27DATE:
01/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Xavier DeAnfrasioTIME COMPLETED:
05:15 PM
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On 01/03/2024 at 2:50 PM LPA Dana Stevens conducted an unannounced Case Management inspection for the purpose of following up on an unusual incident that occurred on 11/29/2023 and was reported by Director on 11/30/2023. LPA Stevens met with Director, Xavier DeAnfrasio and informed him of the reason for the visit.
This facility provides care in 3 classroom:

The following ratios were observed:
Classroom #5 - 9 children present with 2 staff
Classroom #2 - 10 children present with 2 staff
Classroom #4 - 8 children present with 1 staff
.
On 11/30/2023 Director reported that on 11/29/2023 at approximately 9:27 AM, 9 children were present in Classroom 5 with one teacher, Staff 1(S1). As children were gathered for circle time, S1 noticed Child 1(C1) was holding her throat and looked distressed. C1 stated to S1 that she swallowed a gem. C1 was immediately taken to Director who did a health check and called C1's parent. C1's parent arrived at 9:45 am took C1 to Urgent Care. Director stated C1 returned to the school the following week with physician's note of clearance.

LPA inspected inside and outside of facility and interviewed Director, staff and preschool children. Director stated he will email the following to LPA: video of incident, children's roster (LIC 9040), photo (example) of gem swallowed,.

Due to insufficient information at this time this incident requires further investigation.

Exit interview conducted and copy of this report left with Director. Notice of site visit must be posted for 30 days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2024
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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