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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374844848
Report Date: 01/10/2020
Date Signed: 01/10/2020 01:43:43 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
374844848
ADMINISTRATOR:DUMAS, NIKOLEFACILITY TYPE:
840
ADDRESS:4174 AVENIDA DE LA PLATATELEPHONE:
(760) 450-7046
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:13CENSUS: 0DATE:
01/10/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:23 PM
MET WITH: Nikole DumasTIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Otsanya Cameron conducted a visit to the facility. Licensee is currently on Inactive Status and has requested to place her license on Active Status. There are no school -age children present at this time.

Due to request for change of room designation and a request for capacity increase, Licensee will remain on inactive status. Licensee submitted a new 9211 to remain on inactive status until 2/10/2020 Licensee agrees to remain current on all fees and will contact LPA, if license needs to be placed on Active Status prior to expiration date.

A Notice of Site visit was issued, along with a copy of this report.
No deficiencies cited at this time.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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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