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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701506
Report Date: 01/05/2024
Date Signed: 01/06/2024 01:52:19 PM

Document Has Been Signed on 01/06/2024 01:52 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 - INFANTFACILITY NUMBER:
376701506
ADMINISTRATOR:XAVIER DEANFRASIOFACILITY TYPE:
830
ADDRESS:3844 ADAMS AVENUETELEPHONE:
(619) 301-7025
CITY:SAN DIEGOSTATE: CAZIP CODE:
92116
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 17DATE:
01/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Xavier DeanfrasioTIME COMPLETED:
03:00 PM
NARRATIVE
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On 1/05/2024, at 1:20 p.m., Licensing Program Analyst (LPA) Cindy Meier conducted an unannounced Case Management inspection to follow upon on the Unusual Incident reported to the Department on 11/30/2023. Upon arrival, LPA met with Director, Xavier Deanfrasio, and discussed the purpose of the inspection. LPA was led on a tour of the facility. There were seventeen (17) infants present and six (6) staff during the inspection.

Based on interviews conducted and video footage of the incident, it was determined that on 11/29/2023, staff (S1) asked staff (S2) to open the door for the substitute teacher to enter the facility. S2 had already left the classroom, leaving S1 with the children. S1 left the classroom to open the door for the substitute, resulting in the children being unsupervised for approximately 4-5 seconds.

Per California Code of Regulations, (Title 22, division 12 & Chapter 1) one (1) Type A citation is being cited on the attached LIC 809-D.



LPA Cindy Meier informed Director, Xavier Deanfrasio, that this report dated 1/05/24 document(s) (1) Type A citation which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Cindy Meier informed the Director, Xavier Deanfrasio to provide a copy of this licensing report dated 1/05/24 that documents the 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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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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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 ADAMS AVENUE - INFANT
FACILITY NUMBER: 376701506
VISIT DATE: 01/05/2024
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An exit interview was conducted with Director, Xavier Deanfrasio, a copy of this report along with the Appeals Rights (LIC 9058) was provided. A Notice of Site Visit is provided and required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. LPA observed Director post Notice of Site Visit to the door at the entrance.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/06/2024 01:52 PM - It Cannot Be Edited


Created By: Cindy Meier On 01/05/2024 at 02:26 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 ADAMS AVENUE - INFANT
FACILITY NUMBER: 376701506

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/05/2024
Section Cited
CCR
101429(a)(1)

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(a) In addition to Section 101229, the following shall apply:

(1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times.

This requirement was not met as evidenced by:
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Director stated that on 12/1/2023 the staff involved in the incident participated in training that reviewed supervision policies and procedures emphasizing the importance of visual supervision, communication, and transitions. On-going staff development is scheduled for all staff which will cover topics such as visual supervision and transitions. Director will submit to SDRO the agenda for the next scheduled staff meeting that states the topics covered.

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Based on interviews conducted and records reviewed, the licensee did not comply with the section cited above, as S1 left the classroom which resulted in the children being left unsupervised for approximately 4-5 seconds which poses an immediate Health and Safety risk for 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:Jason Garay
LICENSING EVALUATOR NAME:Cindy Meier
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2024


LIC809 (FAS) - (06/04)
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