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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020849
Report Date: 09/28/2022
Date Signed: 09/28/2022 05:14:09 PM

Document Has Been Signed on 09/28/2022 05:14 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:EVERBROOK ACADEMY, LLCFACILITY NUMBER:
198020849
ADMINISTRATOR:FUENTEZ, TERESAFACILITY TYPE:
850
ADDRESS:520 W. BASELINE RD.TELEPHONE:
(909) 399-0081
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 132TOTAL ENROLLED CHILDREN: 132CENSUS: 34DATE:
09/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Teresa FuentezTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced case management inspection on 09/28/2022. A COVID 19 risk assessment was conducted prior to entering the facility. LPA arrived at the facility at 3:15 pm and met with Director, Teresa Fuentez who provided a tour of the facility. There were 34 children and 4 staff present during the inspection.

The purpose of today's inspection is to go over the water lead test results received on 09/19/2022. Results indicate that 5 water sources had action level exceedance of lead. The restroom sink located in the Brook Room, Preschool Room, Pre-kindergarten Room, Junior Kindergarten Room and Twos Room had resulted in higher levels of 5.5 ppb. Director has called the company who conducted testing to provide LPA with the levels of lead for each restroom sink. LPA observed that faucets are not accessible through signage with bags and tape to make them inaccessible to children in care. LPA spoke with the Director who stated that the children are provided water from a Brita Filtration Pitcher using individual dixie cups. The restroom sinks are only used for hand washing. LPA asked if children brush their teeth while at school and Director stated they do not. LPA did not observe any tooth brushes in classroom. LPA took pictures of each restroom sink in each classroom listed in this report during the inspection. A deficiency was not cited as the restroom sinks are not used for drinking. The Director did state that the facets will be changed out between the dates of October 4, and 5, 2022. Director will provide LPA with a report stating that facets have been changed out and a new report of testing will be conducted again. Director has ensured LPA that the water faucets noted will not be used as a drinking source or food preparation source for the children.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EVERBROOK ACADEMY, LLC
FACILITY NUMBER: 198020849
VISIT DATE: 09/28/2022
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Director will provide via email the document Child Care Center Sampling Check List Form (LIC 9276). LPA currently has a copy of the External Water Sampler Self-Certification Form (LIC 9275) and a facility sketch marked with circle that indicate each restroom sink that is inaccessible at this time.

Exit interview conducted and report was reviewed, along with appeal rights given to Director, Teresa Fuentez. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC809 (FAS) - (06/04)
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