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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173007616
Report Date: 07/18/2019
Date Signed: 07/18/2019 02:33:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:LEARNING HOUSE - P/S, THEFACILITY NUMBER:
173007616
ADMINISTRATOR:ANNA ROSE MONTANEZFACILITY TYPE:
850
ADDRESS:14840 BURNS VALLEY ROADTELEPHONE:
(707) 995-2076
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY:65CENSUS: 49DATE:
07/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Stacy HallstedTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Chris Arnhold arrived to this facility unannounced to conduct a case management visit in regards to an incident report submitted to CCL on 06/05/2019. The incident involved a child who received an injury to the thumb when they placed it in the door jam. LPA toured the building and inspected the location of the incident. The teacher at the time was exiting out the door and when the door closed a child stuck their thumb in the jam. The area next to the door is a "quiet area" for children to sit calmly. At the time of the incident, there was a small group of children in that location. LPA observed that when the door is opened, light shines through the gap and could cause a child to place a finger in the gap. The facility redirects children from the doorway to ensure no other injury occurs in the future. The medical needs of the child were attended to and a parent transported the child to the hospital for treatment. The child returned to the facility the following day.
Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
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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