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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408262
Report Date: 01/27/2023
Date Signed: 01/27/2023 01:03:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/23/2023 and conducted by Evaluator Michelle Sutton
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230123154240
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
073408262
ADMINISTRATOR:ROBYN KINGFACILITY TYPE:
830
ADDRESS:4831 LONE TREE WAYTELEPHONE:
(925) 281-7640
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:32CENSUS: 22DATE:
01/27/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Raiya PonnaluriTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Staff revealed confidential information
INVESTIGATION FINDINGS:
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On 1/27/23 at 10:00 AM Licensing Program Analysts (LPAs) Michelle Sutton and Cherie Acosta conducted a Complaint Investigation at Learning Experience and met with owner Raiya Ponnaluri. During the course of the investigation, LPA inspected the facility and conducted interviews. It was determined that staff revealed confidential information which puts children's health and safety at risk. Based on the interviews which were obtained throughout the investigation, the preponderance of evidence standard has been met, Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the owner Raiya Ponnaluri.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 02-CC-20230123154240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 073408262
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2023
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights(a) The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidence by;
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Owner agrees to develop a written plan of action to ensure there are no future incident. A copy of the plan shall be sent to CCL by 2/10/23.
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Based on interviews it was confirmed that staff revealed confidential information. This is an potential risk to Health and Safety or Personal Rights risk to persons in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violation are $250 per violation and $100 per day until corrected.
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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.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
LIC9099 (FAS) - (06/04)
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