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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407833
Report Date: 05/11/2021
Date Signed: 05/14/2021 09:18:59 AM

Document Has Been Signed on 05/14/2021 09:18 AM - 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:LEARNING EXPERIENCE-PRESCHOOL, THEFACILITY NUMBER:
485407833
ADMINISTRATOR:KELLEY, BONNIEFACILITY TYPE:
850
ADDRESS:1959 PEABODY ROADTELEPHONE:
(707) 305-4336
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 120TOTAL ENROLLED CHILDREN: 0CENSUS: 18DATE:
05/11/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Bonnie KelleyTIME COMPLETED:
10:54 AM
NARRATIVE
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An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Martinez who met with licensee Bonnie Kelley. This visit was conducted via tele-inspection due to the Covid-19 State of Emergency. This visit was conducted for the purpose of following up on a self reported incident that was called into Community Care Licensing (CCL) on 05/07/2021. The licensee stated that on 5/7 a classroom was transitioning from the current classroom to another one across the hall. The licensee stated the child left the line to use the restroom in the classroom and the two teachers proceeded with moving the other children to the new classroom without noticing child C1 was missing. After transitioning the two teachers attempted to add dropped off children in the classroom and counted all the children when they noticed a child was missing. A teacher S1 returned to the previous classroom when it was noted that the child was grabbing articles of clothing out of a cubby and looking for staff. According to staff this entire incident occurred within 10 minutes. This incident constitutes a lack of supervision. The incident was reported to CCL within 24 hours or the next business day, as required. The licensee stated that she would be conducting a staff meeting on 5/14/21 with all teachers, will be initiating a new name to face protocol that will require staff to mention the number of children in the classroom as well as their name. The licensee stated she has listed safety habits in the classroom to remind staff of all new protocols. The following violation of the CA Code of Regulations, Title 22; Division 12 or Health and Safety Code, were observed: see LIC 809D. Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file. This report was reviewed with the licensee and appeal rights were provided.
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Mikah Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2021
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 05/14/2021 09:18 AM - It Cannot Be Edited


Created By: Mikah Martinez On 05/11/2021 at 10:08 AM
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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: LEARNING EXPERIENCE-PRESCHOOL, THE
FACILITY NUMBER: 485407833

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/12/2021
Section Cited
CCR
101229(a)(1)

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The licensee shall provide care and supervision as necessary to meet the children's needs.(1)No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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The licensee is going to send in a copy of the new listed protocols maintained in each classroom as well as a list of topics discussed in the 5/14/21 staff meeting. The licensee will have parents sign the LIC9224 document and maintain them in each child's file for the preschool classroom. This shall be sent in to CCL no later than 5/12/21.
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This is an immediate health and safety risk to children in care. The staff failed to notice a child had remained in the initial classroom during a transition that resulted in the child being left alone for approximately 10 minutes.
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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:Erin Virrueta
LICENSING EVALUATOR NAME:Mikah Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2021


LIC809 (FAS) - (06/04)
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