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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845719
Report Date: 11/24/2021
Date Signed: 11/29/2021 12:07:59 PM

Document Has Been Signed on 11/29/2021 12:07 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:
364845719
ADMINISTRATOR:SHANNON GARCIAFACILITY TYPE:
830
ADDRESS:1025 PARKFORD DRTELEPHONE:
(909) 343-5460
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 32TOTAL ENROLLED CHILDREN: 26CENSUS: 12DATE:
11/24/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director, Shannon GarciaTIME COMPLETED:
04:35 PM
NARRATIVE
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On 11/24/2021 at 10:00am, Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility to conduct an inspection for a separate purpose. During this inspection, LPA toured the facility, took census and verified staff's criminal record clearances and association to facility.

While touring the facility and verifying facility associations, LPA Hogue observed three staff members present and working at the facility without a Criminal Record Clearance Transfer Request. Staff #1 - Staff #3 have an active fingerprint clearance, however the Licensee/Director did not submit a request to have these individuals associated to the facility license.

In accordance with Title 22 Regulation, 101170(h)(1) - (h) Violation of Section 101170(e) will result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the Department. (1) Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days.

See LIC809D for cited deficiency. A Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

Upon receipt of this report, the Director shall post any licensing report documenting a Type A deficiency (LIC809 & LIC809D). The report and the Notice of Site Visit shall be posted for 30 days. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months. The Acknowledgement of Receipt (LIC9224) form must be maintained in each child’s file immediately upon receipt from the parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC9224). An exit interview was conducted, and a copy of this report and appeal rights (LIC9058) was provided to Director Shannon Garcia on this date.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE: DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 11/29/2021 12:07 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Destinee Hogue On 11/24/2021 at 01:55 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 364845719

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
11/24/2021
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance. (e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f)
This requirement is not met as evidenced by:
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Immediately (within 24 hours), Licensee/Director agrees to submit LIC9182-Criminal Background Clearance Transfer Request, LIC508-Criminal Record Statement, and Copy of Driver's License or ID card for Staff #1-Staff #3. LIC9182, LIC508, and Copy of ID can be submitted via email, fax, or mail.
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Based on records review, the licensee did not comply with the section cited above. S#1-S#3 have an active fingerprint clearance, however the Licensee/Director did not submit a request to transfer and associate S#1-S#3 to facility license. This poses an immediate health, safety and personal rights risk to persons in care. A Civil Penalty has been assessed.
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During this inspection, LPA Hogue provided associations_disassociations862@dss.ca.gov email address to Director Shannon. Also, during this inspection, Director created a Guardian Agency account and the Licensee/Director now has access to process associations and disassociations to facility license.

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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:Kimberly Williams
LICENSING EVALUATOR NAME:Destinee Hogue
LICENSING EVALUATOR SIGNATURE:
DATE: 11/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/24/2021


LIC809 (FAS) - (06/04)
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