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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407834
Report Date: 05/26/2023
Date Signed: 05/26/2023 06:52:42 PM

Document Has Been Signed on 05/26/2023 06:52 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:JENNIFER HANSENFACILITY TYPE:
830
ADDRESS:1959 PEABODY ROADTELEPHONE:
(707) 305-4336
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 46TOTAL ENROLLED CHILDREN: 35CENSUS: 28DATE:
05/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Biane Isbeih - Center DirectorTIME COMPLETED:
07:00 PM
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A Required 1-Year inspection was made to the facility by Licensing Program Analysts (LPAs), Melchisedeck Augustin and Robert Maciel. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Center Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.


There were four teachers, and two Aides were supervising twenty-eight children in two Infant A, Toddler, Toddler A, and Toddler B classrooms. Operating hours are 6:30am - 6:00pm, Mon-Fri. The facility was toured inside and outside, and the floor and yard plan were verified. Activity space for infants is separate from other age groups. The items which could pose a danger to children (detergents and cleaning compounds) were inaccessible to children. LPAs did not observe any poison(s). The facility was free of flies, insects and rodents. The toys, floors, and other equipment and surfaces appeared clean, toxic free, safe for infants and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors. The infant changing tables have at least 3" sides and sanitary vinyl pads that are at least 1" thick and a sink that is within an arm’s reach. There was sufficient napping equipment (cribs and cots) available that met the requirements. A current menu was posted, and food prep areas are clean. Food is properly stored and refrigerated as needed. The playground was free of hazards. The playground equipment and surface areas appeared in safe condition. There was artificial turf underneath the high climbing structure to absorb falls. There was at least one working carbon monoxide detectors in each classroom, and smoke detectors are hard wired. There is a fire extinguisher rated at least 2A10BC. There were no bodies of water observed. The Licensee stated no weapons are stored on site and none were observed. (Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 05/26/2023
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During today's inspection, infant/toddler staffing ratios were being met and children were being directly supervised by staff, and the facility was operating within the licensed capacity. At least one staff member present possessed current Emergency Medical Services Authority (EMSA) approved CPR and First Aid certifications which expired on 02/09/2024.

Five children’s (C1-C5) records were reviewed at 1:43pm and the children’s Infant Needs and Service Plan had not been updated within the past three months. Five (S1-S5) staff records were reviewed at 2:27pm, which revealed S1 & S2 were proof of immunity against Influenza, S3 was missing proof of immunity against Measles, Pertussis and Influenza, and S5 missing Influenza. Furthermore, S2 was missing evidence of negative TB clearance and staff records did not include duties of employee and did not comply with California Code of Regulations 101217(a)(3).



This facility is providing Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices brochure, were reviewed and discussed with the director. All licensing reports are public information and must be made available upon request for at least three years.

LPA discussed the safe sleep regulations with Center Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. (Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 05/26/2023
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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. The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/26/2023 06:52 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 05/26/2023 at 05:47 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
, 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: 05/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on five staff (S1-S5) records reviewed at 2:27pm, which revealed S1 & S2 were missing proof of immunity against Influenza, S3 was missing proof of immunity against Measles, Pertussis and Influenza, and S5 missing Influenza. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2023
Plan of Correction
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Licensee stated she would ensure staff obtain their required immunization, and Licensee intends to submit staff required immunization records to the Department by 06/05/23 via mail, email or fax: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on five staff (S1-S5) records reviewed at 2:27pm which revealed S2 was missing evidence of negative TB clearance. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2023
Plan of Correction
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Licensee stated she would ensure S2 obtain evidence of negative TB clearance and Licensee intends to submit S2's evidence of negative TB clearance to the Department by 06/05/23 via mail, email or fax: 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.
SUPERVISOR'S NAME:Leslie Lepori
LICENSING EVALUATOR NAME:Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 05/26/2023 06:52 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 05/26/2023 at 05:47 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
, 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: 05/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)(8)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (8) Duties of the employee.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on five staff (S1-S5) revords reviewed at 2:27pm which revealed the records did not contain duties of employee. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2023
Plan of Correction
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Licensee stated she would complete produce detailed duties of the employees, and submit evidence of completion to the Department by 06/05/23 via mail, email or fax: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099
Type B
Section Cited
CCR
101419.3(a)
Modifications to Infant Needs and Services Plan
(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on five children's (C1-C5) records reviewed at 1:43pm, which revealed several infants Needs and Services plan had not been updated within the last three months. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2023
Plan of Correction
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Licensee stated she would ensure all infant needs and services plans were up to date quarterly.
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:Leslie Lepori
LICENSING EVALUATOR NAME:Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023


LIC809 (FAS) - (06/04)
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