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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750096
Report Date: 04/24/2023
Date Signed: 04/24/2023 06:08:30 PM

Document Has Been Signed on 04/24/2023 06:08 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
197750096
ADMINISTRATOR:SARAH MITCHELLFACILITY TYPE:
830
ADDRESS:24615 COPPER HILL DRIVETELEPHONE:
(661) 904-9530
CITY:SANTA CLARITASTATE: CAZIP CODE:
91354
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 3DATE:
04/24/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
05:52 PM
MET WITH:Sarah Mitchell, DirectorTIME COMPLETED:
06:20 PM
NARRATIVE
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On 04/24/23, Licensing Program Analyst (LPA) Justeene Tamayo and Licensing Program Manager (LPM) Mariela Ramon conducted a case management deficiencies inspection. LPA and LPM met with Director Sarah Novak for the purpose of addressing a deficiency that occurred at the facility. The Department learned that on our about December 2022, there were two confirmed case of hand, foot, and mouth disease.

Per Director, an infant was diagnosed with hand, foot, and mouth disease, including a staff member. Director sanitized the classrooms and notified the parents. Infant and staff did not return to the facility until they were cured from the disease.

The facility did not complete an Unusual Incident Report and did not contact the Department via telephone concerning the hand foot and mouth disease incidents.

A type B citation was issued and provided to Director Sarah Novak. Please see LIC809-D for deficiency cited.

An exit interview was conducted. A copy of this report, Notice of Site Visit, and appeal rights were provided and given to Director Sarah Mitchell.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2023
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 04/24/2023 06:08 PM - It Cannot Be Edited


Created By: Justeene Tamayo On 04/24/2023 at 05:58 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 197750096

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2023
Section Cited
CCR
101212(d)(1)(e)

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101212 (d)(1)(e) Upon the occurrence...a report shall be made to the Department by telephone or fax within the Department's next working day...a written report...shall be submitted within seven days following the occurrence of such event. Events reported shall include the following: Epidemic outbreaks. This requirement is not met as evidenced by:
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Per Director, she will provide an LIC624 concerning this incident no later than 05/08/23 via email to the Department.
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On our about December 2022, an infant and staff member was diagnosed with hand, foot, and mouth disease. The facility failed to report the incident within 24 hours, and did not submit an Unsual Incident Repport within 7 days of the occurrence. This is a type B deficiency, that if not corrected, it poses a potential risk to the health and safety 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.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2023


LIC809 (FAS) - (06/04)
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