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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407834
Report Date: 06/16/2023
Date Signed: 06/16/2023 11:19:44 AM

Document Has Been Signed on 06/16/2023 11:19 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LEARNING EXPERIENCE-INFANT, THEFACILITY NUMBER:
485407834
ADMINISTRATOR:BIANE ISBEIHFACILITY TYPE:
830
ADDRESS:1959 PEABODY ROADTELEPHONE:
(707) 305-4336
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 46TOTAL ENROLLED CHILDREN: 0CENSUS: 25DATE:
06/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Biane Isbeih and Jiayuan LouTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted a Plan of Correction (POC) visit and met with Center Director, Biane Isbeih to follow up on several outstanding POC. On 05/26/23, the facility was cited because the Infant Needs and Services Plan had not been updated quarterly, S2 was missing evidence of negative TB clearance, and S1, S2, S3 & S5’s records did not contain required immunization records. The facility's POC due date was on 06/05/23 and the Department provided the facility with multiple reminders to submit the outstanding POC, however; the facility had not submitted its POC.

During today's visit, LPA reviewed three staff (S1, S2 & S5) records at 8:28am which revealed S2 was missing evidence of negative TB clearance. LPA reviewed nine children's (C1-C9) records at 8:50am which revealed C1-C4, C6 & C7-C8's Needs and Service Plans had not been updated. Discussion with CD indicated S2 was actively attempting to obtain evidence of negative TB clearance and S3 was no longer employed at the facility, and CD requested additional time to obtain the evidence. The Department is granting the facility an extension on the POC due date and S2's evidence of negative TB clearance will be due on 06/30/23. LPA is assessing a civil penalty of $1100 for not ensuring that the Infant Needs and Services Plans were up to date and not correcting the POC.

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. Exit interview conducted and report was reviewed with the Center Director. Appeal Rights were provided.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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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