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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845718
Report Date: 10/13/2021
Date Signed: 10/13/2021 04:04:07 PM

Document Has Been Signed on 10/13/2021 04:04 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:
364845718
ADMINISTRATOR:SHANNON GARCIAFACILITY TYPE:
850
ADDRESS:1025 PARKFORD DRTELEPHONE:
(909) 343-5460
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 94TOTAL ENROLLED CHILDREN: 94CENSUS: 53DATE:
10/13/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Shannon GarciaTIME COMPLETED:
04:30 PM
NARRATIVE
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On 10/13/2021 at 8:30am Licensing Program Analyst (LPA) Justin Giese arrived at the facility to conduct a Proof of Corrections Visit for Type B Citations issued on 09/29/2021 during a required 1 year inspection . LPA was granted entry by Director Shannon Garcia. LPA toured the facility, took census, reviewed records, and observed and/or discussed the following:

The following Proof of Corrections have been verified by LPA during this visit:
  • Verification of Mandated Reporter Certificates
  • Verification of Teacher qualifications (transcripts)

The following corrections pertain to staff immunizations and staff health screenings. Due to Covid-19 restrictions and delays in service, facility Staff have scheduled appointments to obtain necessary paperwork for future dates. Once completed and obtained, documents will be submitted to LPA for verification on or before extended Proof of Correction date of 11/03/2021
  • LIC-503 Health Screening Report - Facility Personnel
  • Staff Immunizations

The following correction was not completed at time of visit. Please see LIC809D for Type B Citation.
  • LIC9224 Receipt of Licensing Reports

Multiple children's files were missing LIC9224, Receipt of Licensing reports for Type A citations the facility received on 06/29/2021 and 09/29/2021. This poses a potential health, safety or personal rights risk to persons in care.

A Civil Penalty of $250 will be assessed during this inspection for Repeat Violation.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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 10/13/2021 04:04 PM - It Cannot Be Edited


Created By: Justin Giese On 10/13/2021 at 03:00 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: 364845718

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/03/2021
Section Cited
HSC
1596.8595(c)

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A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care...This requirement is not met as evidenced by:
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Director understands the importance of this regulation and will complete a full audit of all Child files and obtain missing LIC9224 forms for violations cited on 06/29/2021 and 09/29/2021. LPA will conduct an onsite review of children's files on or before proof of correction date.
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Based on LPA’s observation and record review the licensee did not comply with the section cited above.Multiple children's files were missing LIC9224, Receipt of Licensing reports for a Type A citations the facility received on 06/29/2021 and 09/29/2021. This poses a potential health, safety or personal rights risk to persons in care.
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A Civil Penalty of $250 will be assessed during this inspection for Repeat Violation.

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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:Gilbert Sena
LICENSING EVALUATOR NAME:Justin Giese
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2021


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 364845718
VISIT DATE: 10/13/2021
NARRATIVE
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Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”.

YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.


LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility. Licensees understands that the Notice of Site Visit must remain posted for the next 30 days

Exit interview conducted and report was reviewed with the Facility representative, Shannon Garcia.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
LIC809 (FAS) - (06/04)
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