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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701505
Report Date: 01/30/2024
Date Signed: 01/30/2024 12:31:09 PM

Document Has Been Signed on 01/30/2024 12:31 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: 44CENSUS: 28DATE:
01/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Francisca LumabanTIME COMPLETED:
12:30 PM
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On 01/30/2024 at 12:00 PM LPA Dana Stevens conducted an unannounced Case Management inspection for the purpose of following up on an unusual incident (UIR). LPA Stevens met with Assistant Director, Francisca Lumaban and informed her of the reason for the visit. There were 28 children with 6 staff present at the time of the inspection.

An unusual incident report (UIR) was submitted to the San Diego Regional Office (SDRO) on 11/30/2022, reporting that on 11/29/2023 Child 1(C1) swallowed a gem during circle time in Classroom 5.

During the investigation of this incident, LPA inspected inside and outside of facility and interviewed Director, staff, preschool children and parents.

Based on interviews with staff and video footage reviewed, it was found that C1 picked up a gem that had fallen unnoticed on the floor from an earlier supervised activity and put it in her mouth and swallowed it unobserved by Staff 1(S1). S1 and Director took immediate and appropriate measures to assess C1's health and safety upon becoming aware of the incident and the incident was reported timely to parents and to Licensing.

Based on information obtained, although the incident was determined to be accidental and not due to lack of supervision, gems and other small loose objects pose a potential choking hazard to children under 3 years of age and are not appropriate in classrooms where 2 year olds are present.

Technical Advisory note is being issued on the attached LIC 9102.

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