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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842315
Report Date: 05/02/2024
Date Signed: 05/02/2024 12:56:40 PM

Document Has Been Signed on 05/02/2024 12:56 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
334842315
ADMINISTRATOR/
DIRECTOR:		ELENA BOLINGFACILITY TYPE:
850
ADDRESS:12754 LIMONITE AVENUETELEPHONE:
(951) 817-8817
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY: 193TOTAL ENROLLED CHILDREN: 193CENSUS: DATE:
05/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Elena Boling, DirectorTIME VISIT/
INSPECTION COMPLETED:
01:16 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elyse Jones arrived at the facility to conduct a case management inspection in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on April 22, 2024. It indicates that on March 25, 2024 a staff member observed a scratch on a child’s right forearm. The facility could not determine whether the scratches occurred at the facility or over the weekend. When the staff asked the child about the scratch, the child did not disclose any information about what happened. On March 26, 2024 the Authorized Representative for the child informed the facility that the child disclosed a staff member scratched him/her but did not identify which staff member, only that it was not his/her primary teacher. On
March 28, 2024 the Authorized Representative called the facility to inform them that the child retracted his/her original statement and disclosed that it was his/her primary teacher. The facility conducted an internal investigation which determined there was not enough evidence to corroborate the allegations. Accommodations were made for the child but the child was disenrolled shortly after.

See LIC809D for cited deficiencies.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Elena Boling, Director.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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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Document Has Been Signed on 05/02/2024 12:56 PM - It Cannot Be Edited


Created By: Elyse Jones On 05/02/2024 at 12:30 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 334842315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2024
Section Cited
CCR
101212(d)(1)

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Reporting Requirements
(d)Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition,
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This requirement was not met as evidenced by: Based on the record review, the Licensee did not meet the above regulation which poses a potential Safety & Personal Rights risk to the children in care. When there is an incident that alleges a child was injured by staff it should be reported according to Title
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 a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following:...
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22 regulations. The incident was not reported until approximately 30 days after the incident occurred. Director understands Reporting Requirements. The Director agrees to submit a written statement of understanding of the regulation. The written statement is due on or by POC due date of 5-15-2024.

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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:Aaron Ross
LICENSING EVALUATOR NAME:Elyse Jones
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


LIC809 (FAS) - (06/04)
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