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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845719
Report Date: 11/03/2021
Date Signed: 11/03/2021 12:09:30 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: 22DATE:
11/03/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Shannon GarciaTIME COMPLETED:
12:35 PM
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On 11/03/2021 at 8:45am Licensing Program Analyst (LPA) Justin Giese arrived at the facility to conduct a follow-up Proof of Corrections Visit for Type B Citations which were not resolved during a visit on 10/13/2021. 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:
  • LIC-701 Physician's Report - Child Care Centers (Child's Pre-Admission Health Evaluation)
  • Receipt of licensing report that documents any Type A citations

The following outstanding corrections pertaining to staff immunizations and staff health screenings were not completed. Due to Covid-19 restrictions and delays in medical services, facility staff 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 12/01/2021
  • LIC-503 Health Screening Report: (Staff #1 and Staff #2)
  • Staff Immunizations: (Staff #1 and Staff #2)

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: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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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