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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408263
Report Date: 04/04/2023
Date Signed: 04/04/2023 01:10:52 PM


Document Has Been Signed on 04/04/2023 01:10 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
073408263
ADMINISTRATOR:KAMAL, FAUZIAFACILITY TYPE:
850
ADDRESS:4831 LONE TREE WAYTELEPHONE:
(925) 281-7640
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:130CENSUS: 85DATE:
04/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:Rajya PonnaluriTIME COMPLETED:
01:25 PM
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On Tuesday, April 4, 2023, at 10:34 AM, Licensing Program Analyst (LPA) Caroline Colson met with Rajya Ponnaluri, Licensee, for an unannounced case management inspection. There are 85 children and 9 staff including acting director. LPA discussed having a complete Child Care Roster, having the waivers available to review and updating Admissions Agreement.

A copy of this report shall be maintained for 3 years and available for public review upon request.

A Notice of Site Visit was issued and shall remain posted for 30 days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty.

Please visit our website at www.ccld.ca.gov for training videos, forms, and other resources.

Exit interview conducted and report was reviewed with the licensee, Rajya Ponnaluri.

Please See Technical Assistance for Additional Information

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023
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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