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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215668
Report Date: 04/08/2022
Date Signed: 04/19/2022 11:10:26 AM

Document Has Been Signed on 04/19/2022 11:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
566215668
ADMINISTRATOR:SONIA GARCIAFACILITY TYPE:
830
ADDRESS:2003 YOSEMITE AVENUETELEPHONE:
(805) 520-5913
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 40TOTAL ENROLLED CHILDREN: 32CENSUS: 24DATE:
04/08/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Dulce ContrerasTIME COMPLETED:
01:01 PM
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This is an amended copy on report issued on 4/8/2022 to obtain signatures.

On April 8, 2022 at 12:15 PM, Licensing Program Analysts (LPA) Dean Thompson conducted an unannounced Case Management – COVID-19 inspection and met with director Dulce Contreras. LPA informed the purpose for the inspection and completed a COVID-19 pre-screening questions prior to the commencement of the inspection. Director gave LPA a tour of the facility, inside and outside. There were 24 children in care at the time of Inspection.

This inspection is a follow-up on COVID-19 outbreaks reported by facility staff to CCL between 2/9/2022 through 2/14/2022. Director stated, there has not been any other positive cases reported since the last outbreak on 2/14/2022. A Rapid Assistance Support (RAST) call was placed on June 03, 2020.

LPA provided facility with a Covid 19 Child Care Program Self-Assessment Guide form which was submitted to LPA via email on March 22, 2022. LPA observed staff wearing masks upon arrival to the facility. Before entering the facility covid pre-screening questionnaire was given, sanitizer is available throughout the facility, safety posters were posted, and temperature are conducted.

Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 566215668
VISIT DATE: 04/08/2022
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LPA discussed COVID-19 Vaccines, Testing, Face coverings, Essential Protective Equipment and Supplies, Physical Distancing, Ventilation, Isolation for Illness, Cleaning and Disinfection, Hand washing, Food Service and Mealtimes, How to Respond to Exposures or Outbreaks, and Resilience Tips during the Pandemic.

LPA provided the following resources:
- Official Public Health and Child Care Guidance for COVID-19.
- COVID-19 Child Care Resources:
https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources

There were no deficiencies cited during today's inspection.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with director Dulce Contreras

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022
LIC809 (FAS) - (06/04)
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