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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845719
Report Date: 12/01/2021
Date Signed: 12/01/2021 12:48:36 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: 18DATE:
12/01/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Shannon GarciaTIME COMPLETED:
01:00 PM
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On 12/01/2021 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 11/03/2021. 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-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: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
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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