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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020849
Report Date: 08/04/2023
Date Signed: 08/04/2023 05:03:52 PM

Document Has Been Signed on 08/04/2023 05:03 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: 94CENSUS: 62DATE:
08/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Teresa FuentezTIME COMPLETED:
05:00 PM
NARRATIVE
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On 8/3/2023, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced Case Management Incident inspection. The visit was to follow up on an Unusual Incident Report submitted by the facility on 7/25/2023. LPA entered main school office and was met with Director, Teresa Fuentez. Admin Assistant, Lynette Almazan who guided LPA on a tour of the facility, which has 5 classrooms, and a census was taken of 62 children in care with 9 staff members.
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The incident that occurred on 07/25/2023 was reported to the Department on 07/25/2023 via a telephone call and written report was mailed to the Community Care Licensing Department and received on 8/2/2023. The facility reported the incident in a timely manner.

The Unusual Incident reported concerns of a child being left unattended in the classroom by staff. During today's inspection, LPA obtained children’s roster. Per Director facility will be conducting a staff training with name to face procedures on 8/16/2023. Staff and child were not available to interview. According to Director, staff involved had a one-to-one meeting. LPA took photos of classroom and interviewed Director of the incident. Due to insufficient information available at this time, the incident needs further investigation.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted, appeal rights given, and a copy of the report was reviewed and given to Director, Teresa Fuentes.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2023
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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