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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 485407834
Report Date: 05/20/2022
Date Signed: 05/20/2022 03:42:23 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2022 and conducted by Evaluator Melchisedeck Augustin
COMPLAINT CONTROL NUMBER: 13-CC-20220223115456
FACILITY NAME:LEARNING EXPERIENCE-INFANT, THEFACILITY NUMBER:
485407834
ADMINISTRATOR:OLDANI, SABRINAFACILITY TYPE:
830
ADDRESS:1959 PEABODY ROADTELEPHONE:
(707) 305-4336
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:32CENSUS: 13DATE:
05/20/2022
UNANNOUNCEDTIME BEGAN:
02:00 AM
MET WITH:Jennifer Hansen - Center DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility is operating out of ratio
Facility failed to inform children’s parents of positive COVID-19 cases at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted an unannounced subsequent complaint-Investigation visit and met with Center Director, Jennifer Hansen (CD) to deliver the findings regarding the above allegations. LPA, Yang previously met with LS on 03/02/22 to initiate the investigation by discussing the purpose of the visit and obtained a facility roster of the children currently in care. It was alleged the facility is operating out of ratio and the facility failed to inform children’s parents of positive COVID-19 cases at the facility. The report noted on several occasions, one staff was left alone to supervise six infants.

LPA Augustin interviewed LS, LS2, CD, five staff (S1-S5), two adults (A1 & A2), and one parent (P1) from 03/09/22 through 05/17/22. LS’ statement corroborated the allegation when she admitted that two months ago, the Toddler A class operated out of ratio, but LS did not elaborate further on this matter. Secondly, LS and CD denied claims about the facility not informing parents of positive COVID-19 cases and to their knowledge, parents were notified during each outbreak. (Continue to LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 13-CC-20220223115456
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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-INFANT, THE
FACILITY NUMBER: 485407834
VISIT DATE: 05/20/2022
NARRATIVE
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Statements provided staff, adults, and parent provided evidence to corroborate both allegations. Multiple staff, adults, and parent reported they witnessed one staff providing care and supervision for more than four infants. S1 felt the facility was short staff which resulted in one staff being alone with eight infants, S3 reported that three weeks prior to being interviewed, S3 and another staff were left alone to supervise a total of 15 infants between five to fifteen minutes in the infant room, while; S4, A1 and A2 claimed multiple occasions, they either experienced or witnessed one or two staff left alone to supervise between 6 to 20 infants in Toddler B class, as well as other Toddler classes. During LPA’s tour of the facility on 03/09/22, LPA observed S1 caring for a total of 8 infants in Toddler A class, of which seven children were napping and one child was awake. Additionally, one statement noted receiving complaints from parents about LS not notifying them of positive COVID-19 cases, while another statement reported of not being notified of COVID-19 positive cases.

Based on this investigation, there is a preponderance of evidence to show the facility did not respectively comply with staff-infant ratio and reporting requirements of California Code of Regulations (CCR), 101416.5(b) and 101212(f), and therefore; the allegations are substantiated. Exit interview conducted and report was reviewed with the Center Director, Jennifer Hansen. 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. The following California Code of Regulations, Title 22, Division 12, Subchapter 2 violations were cited on the following LIC 9099D. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 13-CC-20220223115456
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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-INFANT, THE
FACILITY NUMBER: 485407834
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2022
Section Cited
CCR
101416.5(b)
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There shall be a ratio of one teacher for every four infants in attendance.

This requirement was not met as evidenced by: Based on statements provided staff, adults, and parent which provided enough evidence to corroborate claim about the facility operating
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Center Director stated the Toddler A & B could only have 8 children maximum and facility is not currently enrolling children until additional staff are hired. Center Director she would submit a written plan detailing the steps the facility has taken thus far to avoid the classroom from operating out of ratio, and the statement would be submitted to the
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out of ratio.

This poses/posed a potential health, safety and/or personal rights risk to the children in care.
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Department by 06/10/22 via mail, email or fax.

Email: melchisedeck.augustin@dss.ca.gov
Fax: 70-588-5099
Type B
05/27/2022
Section Cited
CCR
101212(f)
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The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative.

This requirement was not met as evidenced by: Based on statements provided staff, adults, and parent which provided enough evidence to corroborate claim about the facility not informing parents of positive COVID-19 cases. This poses/posed a potential health, safety and/or personal rights risk(s) to children in care.
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Center Director stated she and the Licensee would read on CCR 101212 and would report all unusual incidents and the Director intends to hold an all staff meeting to review the content of CCR 101212 and would submit the attendance sheet with the siganture of staff that attended to the Department by 06/03/22 via
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mail, email or fax.

Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
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