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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844856
Report Date: 07/22/2022
Date Signed: 07/22/2022 02:43:42 PM

Document Has Been Signed on 07/22/2022 02:43 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, 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: 87DATE:
07/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Belen AcostaTIME COMPLETED:
02:45 PM
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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 07/13/22.

Facility records were reviewed. Children and staff interviews were conducted, and photos of outdoor play area were obtained. Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided to the licensee.

An exit interview was conducted, and a copy of this report and Notice of Site Visit was provided to facility Director, Belen Acosta.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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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