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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408262
Report Date: 08/10/2023
Date Signed: 08/10/2023 01:58:26 PM

Document Has Been Signed on 08/10/2023 01:58 PM - 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
073408262
ADMINISTRATOR:KAMAL, FAUZIAFACILITY TYPE:
830
ADDRESS:4831 LONE TREE WAYTELEPHONE:
(925) 281-7640
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 8DATE:
08/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:36 PM
MET WITH: Fauzia Kamal and Srivasu KakarlaTIME COMPLETED:
02:04 PM
NARRATIVE
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On August 10, 2023 at 9:41am Licensing Program Analyst (LPA) Indira Loza arrived at the facility and met with Director Fauzia Kamal and Co-Owner Srivasu Kakarla.

At approximately 12:36pm LPA observed an infant sleeping in a high chair, and another infant who was done eating and was sitting in the high chair, both children were left unattended.

One Type A deficiency is being cited. This report shall be posted for 30 consecutive days as there is an immediate risk to the safety of the children in care. Also, LPA Loza informed the Director and Co-Owner to provide a copy of this licensing report dated 8/10/23 that documents a Type A citation to parents/guardians of all children currently enrolled. This must be completed by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) must be placed in the child's file for verification.

See 809-D for deficiency cited

Notice of site visit provided and must be posted for 30 days.

Exit interview conducted with Director Fauzia Kamal and Co-Owner Srivasu Kakarla.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
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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Document Has Been Signed on 08/10/2023 01:58 PM - It Cannot Be Edited


Created By: Indira Loza On 08/10/2023 at 01:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 073408262

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/11/2023
Section Cited
CCR
101439(e)(5)

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101439 - Infant Care Center Fixtures, Furniture, Equipment and Supplies -(e) (5) No infant shall be left unattended while in a high chair.This requirement was not met as evidenced by:
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Director shall create a plan aimed at preventing any child from being left sleeping and unattended in a high chair This plan must be emailed to the LPA no later than August 11, 2023. Director shall also have a staff meeting to watch the "Personal Rights" video on the CDSS website and have the staff
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Based on observation, there was an infant sleeping in a high chair and unattended which poses an immediate risk to the health, safety, or personal rights of the chldren 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:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023


LIC809 (FAS) - (06/04)
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