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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215667
Report Date: 10/03/2023
Date Signed: 10/03/2023 02:37:57 PM

Document Has Been Signed on 10/03/2023 02:37 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
566215667
ADMINISTRATOR:DULCE CONTRERASFACILITY TYPE:
850
ADDRESS:2003 YOSEMITE AVENUETELEPHONE:
(805) 520-5913
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 106TOTAL ENROLLED CHILDREN: 106CENSUS: 61DATE:
10/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Zenaida Hernandez-GarciaTIME COMPLETED:
02:35 PM
NARRATIVE
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On October 3, 2023 at 12:55 PM Licensing Program Analyst (LPA) Laura Villanueva made a Case Management-Other inspection. LPA met with acting Director, Zenaida Herandez-Garcia and explained the purpose of the visit. LPA conducted a tour of the facility inside and outside with acting director. LPA observed a total of 61 children under the care and supervision of 8 staff.

Upon arrival at the center the new director introduced herself to LPA. LPA reviewed Guardian Staff Roster and new director (S1) was in process for a fingerprint clearance. S1 has not received criminal record clearance to work. LPA asked S1 how long she has been working at the facility, S1 stated she started working on September 18, 2023. LPA asked acting director how she determined that S1 was clear to work, Acting director states that she called licensing officer of the day and was informed that she didn't need to redo her fingerprints. They looked her up asking for her social security number, date of birth, and driver's license ID number. Acting director was informed that she was in the system and on the roster. Director does not have the name of the person she spoke to at Community Care Licensing. LPA asked acting director for the letter stating that S1 was cleared to work. Acting director stated that she had not received a clearance letter. LPA provided director with Guardian information to follow up on fingerprint clearance: guardian.dss.ca.gov and phone number 1-888-422-5669.

Today, a type A deficiency was cited under Title 22 Division 12 section 101170 Criminal Record Clearance. Appeal rights given.

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed 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.


CONTINUED ON LIC809C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 566215667
VISIT DATE: 10/03/2023
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Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC809 and LIC809C, LIC809D.

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 acting director, Zenaida Hernandez-Garcia.


THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEAR
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/03/2023 02:37 PM - It Cannot Be Edited


Created By: Laura Villanueva On 10/03/2023 at 02:04 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 566215667

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/03/2023
Section Cited
CCR
101170(e)(1)

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101170 Criminal Record Clearance 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 (1) Obtain a California clearance or a criminal record exemption as required by the Department.
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S1 will not return after today until fingerprints have cleared. The director was given Guardian information to follow up on fingerprint clearances for S1 to return to work: guardian.dss.ca.gov and phone number 1-888-422-5669.
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This requirement was not met as evidence by S1 started working 9/18/23 without obtaining a California clearance or a criminal record clearance. This poses an immediate risk to children in care.
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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:George Mingle
LICENSING EVALUATOR NAME:Laura Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023


LIC809 (FAS) - (06/04)
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