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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215668
Report Date: 09/13/2024
Date Signed: 09/13/2024 03:34:18 PM

Document Has Been Signed on 09/13/2024 03:34 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
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: 7DATE:
09/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Marlene Ybarrra & Zenaida GarciaTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
NARRATIVE
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On September 13, 2024 at 10:35 AM, Licensing Program Analyst (LPA) Laura Carone made an unannounced visit to conduct a Case Management-Incident Inspection. LPA met with Director Marlene Ybarra and Assistant Director Zenaida Garcia and explained the purpose of the inspection. LPA, Director and Assistant Director toured the interior and exterior of the center. There were 6 staff caring for 21 children at the time of the inspection.

On September 6, 2024, center Director self reported an incident that occurred with an infant. There were 2 teachers with 7 children present. During lunchtime, around 11:15 AM T1 changed C1's diaper and then placed C1 in a high chair. C1 was not secured in to the straps of the high chair and tray was not secured into place. T3 came into the classroom to relieve T1 for a 10 minute break. T1 left the classroom. T3 went to change a child's diaper and T2 was at the sink/counter area getting lunch ready to serve. Teachers had their backs to the children in the high chairs. C1 fell out of a Ingenuity brand high chair onto the tile floor. C1 fell off the high chair face first bumping his forehead. The high chair seat is 28 1/2 inches off the floor and a total of 43 1/2 inches tall. T2 picked C1 off tile floor. C1 was crying and had a red mark on forehead. Ice was applied to the injury and Director was informed of the incident. Director and Assistant Director called parent to inform of the incident. It was mutually decided between Director and parent that C1 would be picked up and taken to the emergency room for evaluation. Director and Assistant Director called parent and left a voicemail a couple of hours later to follow up on child's condition. Parent called back and spoke to Ass Director and informed her that the doctor evaluated child and he seems fine. He didn't show signs of a concussion or a brain bleed. He did not have an MRI due to the radiation exposure. Parent was to observe child for any abnormal behavior. Child was to be monitored in 2 hour intervals while he slept. Per parent, there were no signs of serious injury to the child; and he was released. Director is pending a copy of the medical report from parent

Continued on LIC809C
SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Laura Carone
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
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: 09/13/2024
NARRATIVE
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The child did not attend the center on 09/09/2024. The Assistant Director called to follow up on the incident on that day. A voicemail was left for parent. When the child retuned to care on 09/10/2024, the parent informed Director that the child did not attend on 09/09/2024 due to a photo shoot. Assistant Director spoke to parent about child's injury, and parent informed her that child was acting normal over the weekend and just just had a bruise on forehead. Assistant Director informed parent that any medical bills would be covered by center.

LPA reviewed teacher files and found that T1's file did not contain a copy of enrollment in child development courses and Mandated Reporter Certificate. Director stated that she had not collected them prior to employment. T1's hire date is 04/12/2024.

Today, deficiencies cited under Title 22 Division 12. Appeal rights given. A type A deficiency was issued for lack of supervision when the incident with C1 occurred. Type B deficiencies were issued for missing transcripts of qualifications of T1 and no Mandated Reporter Training certificate.

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 LIC 809 and LIC 809 D.


Exit interview and review of report was conducted with Director Marlene Ybarra and Assistant Director Zenaida Garcia.


THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.
SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Laura Carone
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 09/13/2024 03:34 PM - It Cannot Be Edited


Created By: Laura Carone On 09/13/2024 at 09:14 AM
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: 566215668

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/13/2024
Section Cited
HSC
101229(a)(1)

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101229(a)(1)Responsibility for Providing Care and Supervision-(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and
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Center will write a plan to ensure this type of incident does not occur in the future and submit to the Department by 09/20/2024. An office meeting at the Santa Barbara Regional Office will be scheduled.
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101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by: T1 did not ensure C1 was secured into a high chair by not utilizing strap and securing tray. This poses an immediate threat 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:Lissete Gonzalez
LICENSING EVALUATOR NAME:Laura Carone
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/13/2024 03:34 PM - It Cannot Be Edited


Created By: Laura Carone On 09/13/2024 at 02:44 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: 566215668

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2024
Section Cited
CCR
101216.2(d)(2)(3)

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101216.2 Teacher Aide Qualifications and Duties-(d) An aide assisting a fully qualified teacher... shall meet the following requirements:(2) Completion of at least two postsecondary semester units...following initial employment, and...(3)Continuation in
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Director will request a copy of enrollment of child development courses and will submit proof to Department by 09/20/2024. An office meeting at the Santa Barbara Regional Office will be scheduled.
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 the educational program...until six units have been completed. This requirement was not met as evidenced by: T1 does not have any documentation of child development units or enrollment in classes on file. This poses a potential risk to children in care.
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Type B
09/13/2024
Section Cited
HSC1596.8662

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1596.8662 -Availability of information regarding and detecting child abuse and neglect training for mandated reporter training...proof of completion. This requirement was not met as evidenced by:
T1's file not containing Mandated Reporter
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Director will request T1 complete Mandated Reporter Training and submit completed certificate to the Department by 09/20/2024.
. An office meeting at the Santa Barbara Regional Office will be scheduled.
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Training certificate. This poses a potential 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:Lissete Gonzalez
LICENSING EVALUATOR NAME:Laura Carone
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024


LIC809 (FAS) - (06/04)
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