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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407833
Report Date: 05/26/2023
Date Signed: 05/26/2023 06:51:12 PM

Document Has Been Signed on 05/26/2023 06:51 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LEARNING EXPERIENCE-PRESCHOOL, THEFACILITY NUMBER:
485407833
ADMINISTRATOR:JENNIFER HANSENFACILITY TYPE:
850
ADDRESS:1959 PEABODY ROADTELEPHONE:
(707) 305-4336
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: DATE:
05/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:49 AM
MET WITH:Biane Isbeih - center directorTIME COMPLETED:
03:00 PM
NARRATIVE
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A required one-year inspection was made to the facility by Licensing Program Analysts (LPAs), M. Augustin and Robert Maciel. LPAs met with center director, Biane Isbeih (CD). The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff have received criminal record and child abuse index clearances or exemptions. Biane Isbeih was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The facility’s operating hours are 6:30AM-6:00PM, Monday-Friday. The facility was toured inside and outside, and the floor and yard plan submitted by the licensee were verified. Sign in/out records were reviewed and in compliance. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. CD stated there are no poisons in the facility, and none were observed during this inspection. LPAs observed the toys, floors, desks and other equipment and surfaces are clean, toxic free, safe, and in good condition. There is uncontaminated drinking water available to children indoors and outdoors using water fountain and individual drinking cups. The children's bathrooms are in safe and sanitary condition. The center’s isolation area for any child who becomes ill while in care is located behind the staff counter. LPAs observed food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. Menus are posted in each classroom. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the facility. Last emergency drill was conducted on 02/23/2023. LPAs observed the playground equipment and surface areas were in safe condition. There is rubber cushioning underneath play equipment to absorb falls. There were no bodies of water observed on the site. Site Supervisor stated no weapons are stored on site, and none were observed.

Continued on LIC 809-C.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: LEARNING EXPERIENCE-PRESCHOOL, THE
FACILITY NUMBER: 485407833
VISIT DATE: 05/26/2023
NARRATIVE
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Continued from LIC 809.

During today's inspection, staffing ratios were being met, 78 children were being supervised by 8 staff. The facility was operating within the licensed capacity and ratio requirements. At least one staff member present during the inspection possessed current CPR and First Aid certifications, which expire 2/09/2024. 5 children’s records were reviewed at 1:20pm and contained complete and current information as required. 5 staff files were reviewed at 2:25PM which revealed S1, S2, S3, S4, and S5 do not have proof of immunity against influenza. S4 and S5 do not have their mandated reporter training certificates, S2 is missing their TB clearance or risk assessment, and S3 and S5 do not have proof of immunity against measles.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided


Continued on LIC 809-C.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 05/26/2023 06:51 PM - It Cannot Be Edited


Created By: Robert Maciel On 05/26/2023 at 05:46 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
, 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: 05/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)(12)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff record review, the licensee did not ensure that all staff have record of Tuberculosis tests which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2023
Plan of Correction
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Licensee stated that she would ensure staff obtain missing tuberculosis records. Licensee intends to submit required records to the department by 06/05/2023
Type B
Section Cited
CCR
101217(a)(8)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (8) Duties of the employee.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff record review, the licensee did not ensure that all staff records contain of duties of the employee which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2023
Plan of Correction
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Licensee stated that she would ensure staff obtain missing duty statement records. Licensee intends to submit required records to the department by 06/05/2023
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:Alexis Hollon
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023


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Document Has Been Signed on 05/26/2023 06:51 PM - It Cannot Be Edited


Created By: Robert Maciel On 05/26/2023 at 05:46 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
, 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: 05/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(2)
Health-Related Services
(2) All prescription and nonprescription medications shall be maintained with the child's name and shall be dated.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not ensure that medication is not expired which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2023
Plan of Correction
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Licensee stated that she will acquire the appropriate medication from the parents the children whom it is prescribed to.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Alexis Hollon
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 05/26/2023 06:51 PM - It Cannot Be Edited


Created By: Robert Maciel On 05/26/2023 at 05:52 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
, 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: 05/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on staff record review at 2:25PM which revealed that several staff records did not contain proof of the required immunization which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2023
Plan of Correction
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Center director stated that she would ensure staff obtain missing immunization records. Center director intends to submit required records to the department by 06/05/2023
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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4
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:Alexis Hollon
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023


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Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: LEARNING EXPERIENCE-PRESCHOOL, THE
FACILITY NUMBER: 485407833
VISIT DATE: 05/26/2023
NARRATIVE
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Exit interview conducted and report was reviewed with, center director, Biane Isbeih.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC809 (FAS) - (06/04)
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