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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844856
Report Date: 08/09/2023
Date Signed: 08/09/2023 11:40:54 AM

Document Has Been Signed on 08/09/2023 11:40 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
334844856
ADMINISTRATOR:BELEN ACOSTAFACILITY TYPE:
850
ADDRESS:515 ALESSANDRO BLVD.TELEPHONE:
(951) 386-2560
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY: 135TOTAL ENROLLED CHILDREN: 135CENSUS: 114DATE:
08/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Belen AcostaTIME COMPLETED:
11:55 AM
NARRATIVE
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On 08/09/2023, Licensing Program Analysts (LPAs) Raymond Moorehead and Laura Mejorado were at the facility on separate matters. LPAs met with Director, Belen Acosta. LPAs toured the facility, took census and verified associations. While touring the facility, LPAs observed a staff member working in the facility whom did not have a completed fingerprint clearance. LPAs verified that the staff member's fingerprint clearance reads that it was in process since 05/17/2023.


The facility was issued a Type A citation for Title 22 Regulation section 101170(e)(1). See LIC 809D for cited deficiencies. Civil penalties were assessed at this time.

LPAs informed Director Belen Acosta that this report dated 08/09/2023 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs informed Director to provide a copy of this licensing report dated 08/09/2023 that documents any Type A citation to parents/guardians of all children currently enrolled 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), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with the Director, Appeal Rights were discussed and issued, a copy of this report was provided, and a Notice of Site visit was issued. The Notice of Site Visit (LIC 9213) shall be posted where the parent/guardian of children enter and exit the facility and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. A copy of this report must be made available for the next three years
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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 08/09/2023 11:40 AM - It Cannot Be Edited


Created By: Raymond Moorehead On 08/09/2023 at 10:45 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 334844856

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/10/2023
Section Cited
CCR
101170(e)(1)

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(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
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Director agrees to submit proof of Livescan for staff member to CCL by 08/10/23 by close of business, via email. LPA advised Director to contact Guardian for further assistance.
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Based on record review, the facility did not comply with the section cited above in 1 staff member that did not have an eligible clearance on file, which poses an immediate health, safety or personal rights risk to persons 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:Aaron Ross
LICENSING EVALUATOR NAME:Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023


LIC809 (FAS) - (06/04)
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