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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407833
Report Date: 06/16/2023
Date Signed: 06/16/2023 11:21:51 AM

Document Has Been Signed on 06/16/2023 11:21 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LEARNING EXPERIENCE-PRESCHOOL, THEFACILITY NUMBER:
485407833
ADMINISTRATOR:BIANE ISBEIHFACILITY TYPE:
850
ADDRESS:1959 PEABODY ROADTELEPHONE:
(707) 305-4336
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 69DATE:
06/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Biane Isbeih - Center DirectorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted a Plan of Correction (POC) visit and met with Center Director, Biane Isbeih to follow up on several outstanding POC. On 05/26/23, the facility was cited because S2 was missing evidence of negative TB clearance, and S1-S5’s records did not contain required immunization records, and C6 & C7’s inhaler and EpiPen were expired. The facility's POC due date was on 06/05/23 and the Department provided the facility with multiple reminders to submit the outstanding POC, however; the facility had not submitted its POC.

During today's visit, LPA reviewed five staff (S1-S5) records at 9:47am which revealed S2 was missing evidence of negative TB clearance, S3 and S5's records did not contain proof of immunity against Measles. According to CD, S2 was actively working on obtaining evidence of negative TB clearance, however; S3 had not provided CD with the required immunization record after CD requested the record from the staff. CD requested for the Department to provide the facility with an extension to obtain S2's evidence of negative TB clearance and there was indication that CD made some attempts to obtain updated medication for C6 & C7, and CD stated she would obtain all required immunization records prior to staff working at the facility. The Department is extending the facility's POC due date and the facility's new POC due date is 06/30/23. A civil penalty of $1100 is being assessed because the facility did not ensure S3 obtained her immunization record prior to working and the facility did not clear or comply with the POC.

A notice of site visit was given and must remain posted 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 the Center Director. Appeal Rights were provided.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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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