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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845718
Report Date: 08/05/2022
Date Signed: 08/05/2022 03:58:42 PM

Document Has Been Signed on 08/05/2022 03:58 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: 140TOTAL ENROLLED CHILDREN: 140CENSUS: 80DATE:
08/05/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Shannon GarciaTIME COMPLETED:
04:15 PM
NARRATIVE
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On 08/05/22, Licensing Program Analyst (LPA) Aman Sharma and Licensing Program Manager (LPM) Kimberly Williams arrived at the facility on another matter. However, during the 08/05/22 inspection, it was observed that there was a staff member (S1) who has a criminal record clearance but is not associated to the facility, S1 was working inside Toddler A classroom, actively supervising children.

See LIC809D for cited deficiencies in accordance with the California Code of Regulations Title 22, Division 12.

An exit interview was conducted, appeal rights discussed and a copy of this report was provided.

A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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 08/05/2022 03:58 PM - It Cannot Be Edited


Created By: Aman Sharma On 08/05/2022 at 03:08 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: 08/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2022
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance. (e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f)...
This requirement was not met as evidenced by:
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Director submitted form LIC9182, LIC508, and copy of photo ID via Guardian during today's visit. S1 is now associated to the facility. Deficiency cleared.
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Based on review of records, it was found that a staff member was supervising children in care with no criminal record fingerprint association to the facility. Staff has an active-working fingerprint clearance, however facility failed to submit a Criminal Background Clearance Transfer Request (LIC9182) to the department.
This poses a potential health, safety, and personal rights risk 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:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022


LIC809 (FAS) - (06/04)
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