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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408263
Report Date: 04/13/2023
Date Signed: 04/13/2023 12:54:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2023 and conducted by Evaluator Ashley Curry
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230407141916

FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
073408263
ADMINISTRATOR:KAMAL, FAUZIAFACILITY TYPE:
850
ADDRESS:4831 LONE TREE WAYTELEPHONE:
(925) 281-7640
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:130CENSUS: 64DATE:
04/13/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Fauzia Kamal/ Rajya PonnaluriTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not report unusual incident to licensing
INVESTIGATION FINDINGS:
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On 04/13/2023 At 9:30AM Licensing Program Analyst (LPA) A. Curry conducted an unannounced complaint inspection and met with director, Fauzia Kamal, to discuss the above allegations. The owner Rajya Ponnaluri arrived later during the visit. The LPA toured the facility, made observations, and conducted interviews with the staff. The allegation is staff did not report unusual incident to licensing. During the course of the investigation, interviews revealed that multiple staff had concerns regarding a child, who came to school with a black eye three times, and did not report it to Licensing. Based on the LPA’s interviews the preponderance of evidence standard has been met. Therefore the above allegation is found to be SUBSTANTIATED.

Director was advised to ensure all staff are aware of what is required as a mandated reporter.

An exit interview was conducted, appeal rights were given, and a copy of this report was provided to the director.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20230407141916
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 073408263
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/11/2023
Section Cited
CCR
101212(d)(1)(C)(D)
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101212Reporting Requirements(d)...a report shall be made... within... next working day and during its normal business hours...written report...shall be submitted to the Department within seven days..(1)Events reported shall include the following:(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child
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By 05/11/2023 the facility will conduct an all staff training on reporting requirements. Facility will submit proof of training to LPA.
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(D) Any suspected physical or psychological abuse of any child.
This requirement was not met as evidence by:
Multiple staff had concerns regarding a child who came to school with a black eye on 3 separate occassions and did not report it to LIcensing.
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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.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
LIC9099 (FAS) - (06/04)
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