<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020850
Report Date: 08/09/2022
Date Signed: 08/09/2022 01:39:55 PM

Document Has Been Signed on 08/09/2022 01:39 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:
198020850
ADMINISTRATOR:FUENTEZ, TERESAFACILITY TYPE:
840
ADDRESS:520 W. BASELINE RD.TELEPHONE:
(909) 399-0081
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 47TOTAL ENROLLED CHILDREN: 40CENSUS: 37DATE:
08/09/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Teresa FuentezTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On August 9, 2022 at 11:10am, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced case management inspection. The purpose of this inspection is to follow up on the COVID-19 outbreak at the facility with Registered Nurse from Department of Public Health, Joseph Tran, and Representative from Environmental Health, John Huynh, as well as Director, Teresa Fuentez. A risk assessment was conducted prior entering the facility and LPA wore an N-95 mask. Upon arrival LPA was greeted by Admin Assistant, Lynette Edwards who took her temperature and asked for identification. LPA toured the school-age classroom and observed 12 children in care with 1 staff who was verified on the Criminal Clearance Report.

During this inspection, DPHRN observed the facilities efforts to mitigate the spread of COVID-19. The facility has implemented temperature checks, indoor mask wearing, hand washing, sanitizing tables before and after meals and activities. DPHRN suggested air purifiers be implemented, and that fans be turned on from the thermostat and blow continuously. DPHRN asked what type of symptoms the staff and children have had and the Director stated that it has been mild fevers and runny noses. Everyone has been cleared to return. He asked, which type of air conditioning filter is used and how often the facility changes them. The Director will be checking with maintenance and provide that information to the DPHRN. The DPHRN will be emailing a report later today, August 9, 2022 and scheduling a virtual call on Thursday, August 11, 2022 to provide further recommendations. He will be including the LPA on the email, as well as on the virtual call.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2022
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: 198020850
VISIT DATE: 08/09/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Prior to arriving at the facility, LPA reviewed the facilities profile and 11 cases of Covid-19 had been reported to the department.

No deficiencies were cited today, and the facility is in compliance with Title 22. Upon receipt, Director Teresa Fuentez was given the Notice of Site Visit. The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.


An exit interview was conducted, and a copy of this report was provided to Director, Teresa Fuentez along with Notice of Site Visit and Appeal Rights.

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

DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2