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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701503
Report Date: 11/02/2021
Date Signed: 11/02/2021 04:27:10 PM

Document Has Been Signed on 11/02/2021 04:27 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 RANCHO SAN DIEGOFACILITY NUMBER:
376701503
ADMINISTRATOR:TINA PROWANTFACILITY TYPE:
850
ADDRESS:3605 AVOCADO BOULEVARDTELEPHONE:
(619) 569-7607
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 72TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/02/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Michael OngTIME COMPLETED:
11:15 AM
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On 11/2/21 at 10:30am, Licensing Program Analyst (LPA), Martha Malane conducted a virtual office meeting via Teams with Applicant, Michael Ong for a Component II Orientation.
LPA and applicant reviewed the facilities NOIA and discussed pending documents. Mr. Ong stated he will submit pending documents to CCL.

An exit interview was conducted with Applicant, Michael Ong. This report was provided.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2021
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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