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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407834
Report Date: 06/08/2022
Date Signed: 06/08/2022 01:58:53 PM

Document Has Been Signed on 06/08/2022 01:58 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
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: 32TOTAL ENROLLED CHILDREN: 29CENSUS: 18DATE:
06/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jennifer Hansen - Center DirectorTIME COMPLETED:
02:10 PM
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Licensing Program Analysts (LPAs), M. Augustin and S. Phouthavong made an unannounced Case Management visit to the facility and met with Center Director, Jennifer Hansen (CD) to investigate the circumstances of an incident which involved an adult (A1) looking into a classroom through the window which resulted in the facility calling the police on 03/18/22 at approximately 5:00pm, and also to determine if the facility complied with reporting requirements of California Code of Regulations (CCR), 101212. The facility did not self-report incident to Community Care Licensing.

During today's visit, LPAs toured the facility and conducted interviews with CD and five staff (S1-S4 & AD) at 10:10am. CD's statement confirmed the incident occurred, however; CD claimed she had already left for the day and was not present at the time of the incident. In addition, CD claimed the incident did not impact the health and safety of the children in care, and the facility took appropriate steps to ensure additional security measures by frosting the classroom window to prevent individuals from looking into the classroom.

Multiple statements provided by staff either confirmed the occurrence of the incident on 03/18/22 or staff had knowledge of the incident. Staff reported seeing A1 knocking on the Infant A class window which prompted staff to report their observation(s) to the facility management which also prompted management to call the law enforcement. According to the statements, law enforcement interacted with A1 away from the facility and law enforcement did not enter the facility. The facility recently met with staff to discuss the requirements of CCR 101212 and the facility is aware of its obligations to comply with reporting requirements.

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. There were no California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06 violations cited during today’s visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2022
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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