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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334842315
Report Date: 12/03/2021
Date Signed: 12/03/2021 10:58:28 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2021 and conducted by Evaluator Elyse Jones
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20211015105317
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
334842315
ADMINISTRATOR:MICHELLE SOLORIOFACILITY TYPE:
850
ADDRESS:12754 LIMONITE AVENUETELEPHONE:
(951) 817-8817
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:193CENSUS: 132DATE:
12/03/2021
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Michelle Solorio, DirectorTIME COMPLETED:
11:03 AM
ALLEGATION(S):
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Staff not meeting daycare child’s dietary needs resulting in allergic reaction.
INVESTIGATION FINDINGS:
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On December 3, 2021, Licensing Program Analyst (LPA) Elyse Jones arrived at the facility to deliver findings for a complaint. LPA conducted a tour of the facility and took census. During the investigation interviews were conducted with pertinent parties and documentation was collected.

On October 15, 2021 a complaint was received alleging staff did not meet daycare child’s dietary needs resulting in an allergic reaction. During interviews with pertinent parties it was disclosed that on the day of the incident, lunch from home was provided for the child due to an allergy on the facility’s menu for that day. Also, during the interviews several staff acknowledged knowing that the child had allergies but did not know one of the food items had an ingredient in it that would cause an allergic reaction. LPA Jones obtained documentation from the child’s file that states the child has an allergy to an ingredient that was being served. LPA Jones also observed an Incidental Medical Plan along with an Epi-Pen for the child. The Licensee stated, after the incident the facility met with the family to discuss their plan to ensure this does not happen again.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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 3
Control Number 09-CC-20211015105317
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 334842315
VISIT DATE: 12/03/2021
NARRATIVE
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In addition to the “Green Band Program” which identifies when a child has a general allergy, the facility has since implemented a “Red Band Program” which identifies when children cannot each the facility lunch.

Based on all the information obtained from pertinent parties, documentation, records review during inspection, the department has determined the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED.

See LIC 809-D for deficiencies.

Exit interview was conducted and a copy of this report and a Notice of Site Visit, Appeal Rights and an
LIC 9224 was provided to the Licensee. Notice of Site Visit must be posted for 30 day. A copy of this report must be made available to the public for three years upon request.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 09-CC-20211015105317
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 334842315
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/03/2021
Section Cited
CCR
101227(7)(B)
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Food Services
(7) Modified diets prescribed by a child's physician as a medical necessity shall be provided. (B) A child shall not be served any food to which the child's record indicates he/she has an allergy. This requirement was not met as evidenced by:
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Licensee has implemented a "Red Band" Program since the incident which alerts staff that the child cannot eat the facility lunch. Licensee agrees to obtain & file an LIC 9224 for each child accroding to the Title 22.
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Based on the interviews and record review, the Licensee did not meet Food Services regulation which poses an immediate Health, Safety & Personal Rights risk to the children in care. During the interviews it was disclosed that staff were aware of Child 1 food allergy. However, staff provided food to the child.
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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: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3