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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009946
Report Date: 07/20/2021
Date Signed: 07/21/2021 02:46:54 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 EXPERIENCE-S/A, THEFACILITY NUMBER:
493009946
ADMINISTRATOR:RETHERFORD, STEPHANIEFACILITY TYPE:
840
ADDRESS:6150 COMMERCE BLVDTELEPHONE:
(707) 585-5990
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:15CENSUS: 4DATE:
07/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Karen ArenaTIME COMPLETED:
01:31 PM
NARRATIVE
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A Case Management inspection was conducted at the facility by Licensing Program Analyst (LPA) Y. Yang in response to a self-reported, Unusual Incident Report (UIR) received 07/16/2021 involving a lack of supervision. The center director reported that on 07/14/21 at 10:45am, during transition from the "school age" classroom to the facility's adjacent office area, school age child C1 was unknowingly left alone inside the classroom's bathroom without supervision by staff S1 for approximately two minutes. The director reported that C1 eventually rejoined their group and was not in distress. The director reported that there were 5 children being supervised by one staff member (S1) at the time of the incident. Interviews corroborate that C1 did not elope from the facility, but did lack supervision for several minutes.

The director reported that staff S1 was immediately spoken to and disciplined. The director reported that S1 was removed of their "lead teacher" position and reassigned as a "floater teacher", who will be supervised by a lead teacher at all times while supervising children. The director reported that the child's parent was notified on 07/14/21. The director reported that staff S1 received additional training on classroom management, transitions, and "name to face" counts. In addition, the director reported that all staff have retrained on "name to face" transitions. During today’s inspection, there were 4 children in care being supervised by 1 teacher. No children were observed to be left without supervision.

Based on available information, it has been determined that staff S1 did not provide supervision to child C1 during the transition on 07/14/2021. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. This report was read and reviewed with the director. Notice of site visit must be posted for 30 days. Appeal rights provided.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 EXPERIENCE-S/A, THE
FACILITY NUMBER: 493009946
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2021
Section Cited

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Responsibility for Providing Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by: the center director's admission on 07/20/21 that on 07/14/21, child C1 was left without supervision of a teacher for several minutes during a transitions while in the "School Age" classroom. This presents a potential threat to the health and safety of children in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2021
LIC809 (FAS) - (06/04)
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