<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105083
Report Date: 03/15/2022
Date Signed: 03/23/2022 12:27:16 PM

Document Has Been Signed on 03/23/2022 12:27 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 POWAYFACILITY NUMBER:
376105083
ADMINISTRATOR:MICHAELA SERBINFACILITY TYPE:
830
ADDRESS:13376 POWAY ROADTELEPHONE:
(858) 382-6106
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 32DATE:
03/15/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Mikaela TIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 3/15/22 at 1:30pm LPA’ Adrian Mangina and Patrick Ma made an unannounced case management - Deficiencies inspection. LPA's met with center Director Mikaela Serbin. During LPA's walk through of the facility, LPAsobserved staff member #1 working with infants in room #4 with three other staff members supervising a total of 7 infants. Upon review of Staff #1's file, Staff #1 possessed a valid criminal record clearance but was not associated to the facility.

See LIC809D for cited deficiencies.

An exit interview was conducted with Facility Representative, Mikaela Serbin. The Licensee was provided a copy of their appeal rights (LIC 9058) along with a copy of this report (LIC 809). Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide Acknowledgement of Receipt of Licensing Reports (LIC 9224) to the parent/guardian of for each child in care for signature acknowledging receipt of copy of this report. THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS. LIC9213 Notice of site visit was provided and must be pasted for 30 days.

SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 03/23/2022 12:27 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 03/15/2022 at 06:36 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 POWAY
FACILITY NUMBER: 376105083

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/16/2022
Section Cited
CCR
101170(e)(3)

1
2
3
4
5
6
7
Criminal Record Clearance: All individuals subject to a criminal record review…shall prior to working, residing or volunteering in a licensed facility: (3) Request and be approved for a transfer of a criminal record exemption… to be employed, reside or be present at the facility. This requirement was not met based on:
1
2
3
4
5
6
7
Representative provided completed Criminal Records Clearance Transfer LIC9182 for staff #1 and LPA processed transfer during the visit. Representative stated that in future she will ensure that all staff are fingerprint cleared and associated to the facility before working with children
8
9
10
11
12
13
14
Based on observation and record review it was determined that Staff #1 Bradley Cheng has been working without proper fingerprint association since 2/14/22 which poses an immediate health and safety risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Renesha Pack
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2