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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408263
Report Date: 09/22/2023
Date Signed: 09/22/2023 01:17:24 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
08/09/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230809135313
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: 59DATE:
09/22/2023
UNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Fauzia KamalTIME COMPLETED:
01:24 PM
ALLEGATION(S):
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Personal Rights - Child received injury while in care
Personal Rights - Facility not changing child's diapers resulting in clothing soaked with urine upon pick up
INVESTIGATION FINDINGS:
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On September 22, 2023 at 10:47am Licensing Program Analyst (LPA) Indira Loza met with Director Fauzia Kamal to complete the investigation for the above complaint. LPA Loza toured the facility for a Health and Safety check. Present during today's visit were 59 children and 9 staff.

During the course of the investigation staff and parents were interviewed, LPA observed the facility, and records were reviewed. Based on staff, parent, and record reviews it has been determined that the child did receive an injury in care where the child's finger got jammed in an electrical outlet on the playground and a part of the fingernail was missing. Also, based on interviews it has been determined that some children were picked up from the daycare with a full diaper. Therefore, these allegation have met the the preponderance of evidence standard and has been concluded as Substantiated. Title 22, California Code of Regulations are being cited on the attached LIC9099D.
Exit interview conducted with Director Fauzia Kamal.
Appeal Rights, Report, Notice of Site visit provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
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
08/09/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230809135313

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: 59DATE:
09/22/2023
UNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Fauzia KamalTIME COMPLETED:
01:24 PM
ALLEGATION(S):
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9
Reporting Requirements - Authorized representative was not notified of injury when child was picked up from care.
INVESTIGATION FINDINGS:
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On September 22, 2023 at 10:47am Licensing Program Analyst (LPA) Indira Loza met with Director Fauzia Kamal to complete the investigation for the above complaint. LPA Loza toured the facility for a Health and Safety check. Present during today's visit were 59 children and 9 staff.

During the course of the investigation staff and parents were interviewed and records were reviewed. Although the child allegation states that the person picking up the child was not notified, the facility has an OUCH report where the parent acknowleged receiving notification of the injury. Therefore, the allegation is unsubstantiated, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Exit interview conducted with Director Fauzia Kamal.
Appeal Rights, Report, Notice of Site visit provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 02-CC-20230809135313
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: 09/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
101223(a)(2)
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(a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by: Based on record review, and
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The Director shall have an all staff meeting to discuss what Personal Rights are and how to be compliant with the regulation; all staff must list what they have learned from the meeting. This shall be emailed to the LPA no later than October 27, 2023.
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parent/staff interviews it has been determined that some children were taken home with a wet diaper and a child injured their finger with an electriacal outlet on the playground; which can be a risk to the health, safety, and personal rights to 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.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4