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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 485407833
Report Date: 05/20/2022
Date Signed: 05/20/2022 03:30:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2022 and conducted by Evaluator Melchisedeck Augustin
PUBLIC
COMPLAINT CONTROL NUMBER: 13-CC-20220223103930
FACILITY NAME:LEARNING EXPERIENCE-PRESCHOOL, THEFACILITY NUMBER:
485407833
ADMINISTRATOR:OLDANI, SABRINAFACILITY TYPE:
850
ADDRESS:1959 PEABODY ROADTELEPHONE:
(707) 305-4336
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:120CENSUS: 64DATE:
05/20/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jennifer Hansen - Center DirectorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Day care child left unsupervised
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted an unannounced subsequent complaint-Investigation visit and met with Center Director, Jennifer Hansen (CD) to deliver the finding regarding the above allegation. LPA, Yang previously met with LS on 03/02/22 to initiate the investigation by discussing the purpose of the visit, requesting personnel records, and a facility roster of the children currently in care. It was alleged that a day care child was left unsupervised. The report noted a child (C1) was left unattended on the play yard for five minutes.

LPA Augustin interviewed LS, LS2, CD, five staff (S1-S5), two adults (A1 & A2), and two parents (P1 & P2) from 03/21/22 through 05/17/22. LS’s statement corroborated the allegation and confirmed a child (C1) exited the line and went to the bathroom without informing staff which resulted in C1 being left in the bathroom without staff supervision while the class had already transitioned to the playground on 02/11/22 at approximately 4:00pm. (Continue to LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 13-CC-20220223103930
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: LEARNING EXPERIENCE-PRESCHOOL, THE
FACILITY NUMBER: 485407833
VISIT DATE: 05/20/2022
NARRATIVE
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Interviews provided by staff, adults, and parent corroborated C1 was left without staff supervision in classroom bathroom for less than 10 minutes. On 03/08/22, the facility submitted an Unusual Incident Report (UIR) which reported C1 went to the bathroom and was left without staff supervision inside Preschool 2 classroom for less than five minutes while the classroom had already transitioned to the outdoor playground.

Based on the investigation, there’s a preponderance of evidence to show there was absence of supervision which resulted in C1 being left without staff supervision in the classroom, and therefore the allegation is substantiated. The facility did not comply with Health and Safety Code (H &SC), 1596.99(c)(3) and an immediate Civil Penalty of $500 is being assessed for absence of supervision. The following Health and Safety Code, Title 22, Division 6, Chapter 3.5 violation is being cited on the following LIC 9099D. Exit interview conducted, and report was reviewed with the Center Director, Jennifer Hansen. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Melchisedeck Augustin informed Center Director, Jennifer Hansen that this report dated 05/20/2022 document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA, Melchisedeck Augustin informed the Center Director to provide a copy of this licensing report dated 05/20/2022 that documents any Type A citation(s) 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.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 13-CC-20220223103930
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LEARNING EXPERIENCE-PRESCHOOL, THE
FACILITY NUMBER: 485407833
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/21/2022
Section Cited
HSC
1596.99(c)(3)
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The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, for any of the following serious violations: Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under
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Center Director stated she would submit a written plan detailing to the Department by 05/21/22 which would detail the steps she already started to implement to comply with supervison requirements, and Center Director intends to hold an all staff meeting to discuss the supervision requirements
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 18 years of age.
This requirement was not met as evidenced by: Interviews provided by staff, adults, and parent which corroborated C1 was left without staff supervision in classroom bathroom for less than 10 minutes which posed an immediate health, safety and/or personal rights riks to the child(ren) in care.
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and she would submit additional evidence of staff training/content discussion for all staff meeting that will be held before 06/03/22.
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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.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
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