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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407834
Report Date: 08/23/2024
Date Signed: 08/23/2024 03:15:31 PM

Document Has Been Signed on 08/23/2024 03:15 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 VACAVILLE-INFANT, THEFACILITY NUMBER:
485407834
ADMINISTRATOR/
DIRECTOR:		BIANE ISBEIHFACILITY TYPE:
830
ADDRESS:1959 PEABODY ROADTELEPHONE:
(707) 305-4336
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 34TOTAL ENROLLED CHILDREN: 31CENSUS: 25DATE:
08/23/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Biane Isbeih -Center DirectorTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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An Annual/Required inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. 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. According to department records, S1 & S2 obtained a criminal record clearance and were present during the visit, but their active clearances were not associated to the license number. As such, an immediate $200 civil penalty is being assessed because the Licensee did not ensure S1-S2's clearances were transferred to the facility license prior to working at the facility. Facility Representative 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 six teachers, and one Aides were supervising twenty-five 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. LPA 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 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. (Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 VACAVILLE-INFANT, THE
FACILITY NUMBER: 485407834
VISIT DATE: 08/23/2024
NARRATIVE
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There was at least one working carbon monoxide detectors in each classroom, and smoke detectors are hard wired. There is a fully charged fire extinguisher rated at least 2A10BC. There were no bodies of water observed. The Facility Representative confirmed that no weapons are stored on site, and none were observed. According to the disaster drill log that was posted on the parent board in the lobby, the facility conducted an emergency disaster drill on 08/05/24.


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 an Emergency Medical Services Authority (EMSA) approved pediatric Cardiopulmonary Resuscitation and First Aid certifications which expired on 08/10/2026. Seven children’s (C1-C7) records were reviewed at 10:51am which revealed C1’s Infant Sleep log was not current and missing Preadmission Health History (LIC 702), C2 was missing Personal Rights (LIC 613A), Consent for Emergency Medical Treatment (LIC 627), Identification and Emergency Information (LIC 700), LIC 702, and Parent Rights (LIC 995), and missing of evidence of 15 minute checks, C3 was missing evidence of 15 minute checks. The children’s Infant Needs and Service Plan were up to date. Seven staff (S1-S7) staff records were reviewed at 11:28am, which revealed S5 was missing proof of immunity against Measles and Pertussis.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the facility was constructed after January 01, 2010, and is exempt from the requirement(s).

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. (Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
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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 VACAVILLE-INFANT, THE
FACILITY NUMBER: 485407834
VISIT DATE: 08/23/2024
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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.

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, Biane Isbeih. 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: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
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Document Has Been Signed on 08/23/2024 03:15 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 08/23/2024 at 12:58 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 VACAVILLE-INFANT, THE
FACILITY NUMBER: 485407834

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101429(a)(2)(B)
Responsibility for Providing Care and Supervision for Infants
(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's review of infant sleep log for Infant A class which revealed that staff did not document 15 minute checks while four infants napped. 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: 09/02/2024
Plan of Correction
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Center Director agreed to conduct 15 minute checks & document the checks on infant sleep logs, and to submit five days worth of current & completed logs for all infants in care. Director intends to submit completed logs to by 09/02/24. Email: melchisedeck.augustin@dss.ca.gov.
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 seven staff (S1-S7) records reviewed at 11:28pm which revealed S4 was required staff Immunization. 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: 09/02/2024
Plan of Correction
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Center Director stated she would ensure S4 obtained her proof of immunity against Measles and Pertussis, and Director intends to submit evidence of S4's required immunization to the department via mail, email or fax by 09/02/24. 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.
SUPERVISOR'S NAME:Leslie Lepori
LICENSING EVALUATOR NAME:Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024


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Document Has Been Signed on 08/23/2024 03:15 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 08/23/2024 at 01:47 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 VACAVILLE-INFANT, THE
FACILITY NUMBER: 485407834

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101170(e)(2)
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 101170(f)

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on department records revealing S1-S2's clearances were not associated to the license number and a $200 civil penalty was assessed because Licensee did not ensure the clearances were transferred. 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: 09/02/2024
Plan of Correction
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The Santa Rosa Regional Office associated S1-S2 to the license on 08/23/24. Director agreed to submit a written statement detailing how the facility would ensure continued compliance with CCR 101170(e)(2).
Type B
Section Cited
CCR
101223(b)(1)(A)
Each authorized representative shall be asked to sign and date the acknowledgement-of-receipt statement at the bottom of the LIC 613A (9/96). This documentation shall be kept in the child's file.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on seven children's (C1-C7) records reviewed which revealed C2's record was missing LIC 613. 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: 09/02/2024
Plan of Correction
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Director stated she would provide C2's parents with Licensing forms 613A, 627, 700, 702, LIC 628 and LIC 995, and Director intends to submit signed forms forms for C2 and LIC 702 for C1 to the department by 09/02/24 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov
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: 08/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024


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