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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845719
Report Date: 10/13/2021
Date Signed: 10/13/2021 04:29:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
364845719
ADMINISTRATOR:SHANNON GARCIAFACILITY TYPE:
830
ADDRESS:1025 PARKFORD DRTELEPHONE:
(909) 343-5460
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:32CENSUS: 21DATE:
10/13/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Shannon GarciaTIME COMPLETED:
04:30 PM
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On 10/13/2021 at 8:30am Licensing Program Analyst (LPA) Justin Giese arrived at the facility to conduct a Proof of Corrections Visit for Type B Citations issued on 09/30/2021 during a required 1 year inspection . LPA was granted entry by Director Shannon Garcia. LPA toured the facility, took census, reviewed records, and observed and/or discussed the following:

The following Proof of Corrections have been verified by LPA during this visit:
  • Verification of Mandated Reporter Certificates

The following corrections pertain to staff immunizations, staff health screenings and children's physician's report. Due to Covid-19 restrictions and delays in service, facility staff and parents/guardians of children in care have scheduled appointments to obtain necessary paperwork for future dates. Once completed and obtained, documents will be submitted to LPA for verification on or before extended Proof of Correction date of 11/03/2021
  • LIC-503 Health Screening Report - Facility Personnel
  • Staff Immunizations
  • LIC-701 Physician's Report - Child Care Centers (Child's Pre-Admission Health Evaluation)

Exit interview conducted and report was reviewed with the Facility representative, Shannon Garcia.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
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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