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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374844847
Report Date: 11/15/2021
Date Signed: 11/15/2021 12:55:20 PM

Document Has Been Signed on 11/15/2021 12:55 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LEARNING EXPERIENCE, THEFACILITY NUMBER:
374844847
ADMINISTRATOR:DUMAS, NIKOLEFACILITY TYPE:
830
ADDRESS:4174 AVENIDA DE LA PLATATELEPHONE:
(760) 940-6932
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 32TOTAL ENROLLED CHILDREN: 30CENSUS: 2DATE:
11/15/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
07:10 AM
MET WITH:Stephanie DavisTIME COMPLETED:
12:59 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Jeanette Sanchez and Ana Noble and Licensing Program Manager (LPM) Pauline Beschorner conducted a Case Management visit on this date to address an issue separate from the complaint investigation (Complaint Control # 10-CC-20211108143710) conducted. During the course of the complaint investigation, it was discovered that sign in records were incomplete.

At approximately 8:15am, it was observed that 15 infants were present in the infant classroom. However, sign in records revealed that only 8 infants were signed in by 8:15am. Based off of record review, by 9:30am, only 13 of 27 infants were signed in. Interview with Assistant Director revealed that it is known that not all parents sign in. Assistant Director takes census of the classrooms to update records. Also observed was that the authorized representatives who do sign in, do so with only initials rather than a full signature.

See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12.

An exit interview was conducted. The appeal rights were discussed and provided along with a copy of this report to Assistant Director Stephanie Davis on this date. A Notice of Site Visit was posted.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2021
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 11/15/2021 12:55 PM - It Cannot Be Edited


Created By: Jeanette Sanchez On 11/15/2021 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEARNING EXPERIENCE, THE
FACILITY NUMBER: 374844847

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2021
Section Cited
CCR
101229.1(a)(1)

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101229.1 Sign In and Sign Out (a)...the licensee shall develop, maintain, and implement a written procedure to sign the child in/out of the child care center...(1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
This requirement was not met as evidenced by:
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Director will submit a copy of a memo to parents reminding them of sign in/sign out requirement. Director will also submit a copy of a staff training regarding sign in/sign out procedure and requirements.
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LPAs and LPM observed that number of children present did not match the number of children sign in. This poses a potential risk to the health and safety of chidlren 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:Stephanie Hudak
LICENSING EVALUATOR NAME:Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2021


LIC809 (FAS) - (06/04)
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