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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215668
Report Date: 08/22/2024
Date Signed: 08/22/2024 10:49:44 AM

Document Has Been Signed on 08/22/2024 10:49 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
566215668
ADMINISTRATOR/
DIRECTOR:		MARLENE YBARRAFACILITY TYPE:
830
ADDRESS:2003 YOSEMITE AVENUETELEPHONE:
(805) 520-5913
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 22DATE:
08/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Marlene YbarraTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
NARRATIVE
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On 8/22/24 at 10:35 Licensing Program Analyst (LPA) Veronica Diaz conducted a Case management incident inspection at the Child Care Center (CCC), for the purpose of following up on an Unusual Incident Report (UIR) not reported by the CCC. Specifically, the incident involved a child in care, C1 was injured while running and hit his head on a toy shelf. LPA met with Director Marlene Ybarra and Assistant Director Zenaida Garcia Navarrete to discuss the purpose of today's inspection. LPA notes 22 children and 6 staff were present during inspection.

Assistant Director Zenaida Garcia Navarrete informed Licensing, C1 was injured while running and hit his head on a toy shelf. Staff provided first aid, staff contacted front desk and front desk contacted parent to pick up C1 due to the injury. Staff completed an in house incident report and Director stated they contacted licensing and was told it doesn't need to be reported if no medical attention was needed, director stated at the time medical treatment wasn't need so UIR report wasn't completed for Licensing . Director contacted parent the day after the incident accrued to see if medical treatment was needed parent stated the C1 was given 3 stitches above his right eyebrow . Parent reported that C1 will be staying home for a few days. C1 continued to be enrolled for a month after the incident.

LPA and Director discussed reporting requirements. LPA reminded Director and Assistant Director to always report when medical treatment is needed, even if they are not sure and they feel there may be a possibility that medical treatment may be needed to call licensing and submit a UIR. LPA printed reporting requirements from Title 22 and gave to Director Marlene Ybara.

CONT 809-C

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 566215668
VISIT DATE: 08/22/2024
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LPA investigated this incident and based interview with Director and Assistant Director, P1, record reviews and LPA personal observation there is sufficient evidence that the CCC failed to report a UIR. Therefore, the following Technical Violation was given 101212 (a) (d) (1) (B) Reporting Requirements

During today’s inspection technical violation was provided regarding reporting requirements.



Exit interview and review of report was conducted with Director Marlene Ybarra Notice of Site visit was provided and must remain posted for the next 30 days.
SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
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