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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020851
Report Date: 02/24/2023
Date Signed: 02/24/2023 04:29:14 PM

Document Has Been Signed on 02/24/2023 04:29 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:
198020851
ADMINISTRATOR:FUENTEZ, TERESAFACILITY TYPE:
830
ADDRESS:520 W. BASELINE RD.TELEPHONE:
(909) 399-0081
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 26TOTAL ENROLLED CHILDREN: 25CENSUS: 18DATE:
02/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Teresa FuentezTIME COMPLETED:
01:00 PM
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On February 24, 2023 at 9:00 AM, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced case management inspection at the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with Admin Assistant, Lynette Edwards who guided LPA on a tour of the facility. LPA observed 18 children in care with 5 staff. Director, Teresa Fuentez arrived approximately around 10 am.

Brief Summary of Incident: On 11/14/2022 during nap time at approximately 2:00 PM, Child #1's (C1's) mother (Parent #1/P1) spoke with Director and reported that on 11/14/23 at approximately 2:30 PM she saw Staff #1 (S1) on Sprout About monitors inappropriately handle her son (C1) and another Child #2 (C2). P1 stated she observed S1 pick-up C1 and C2 underneath their arms and return them to their cots.

During this investigation, LPA interviewed, Director, staff #1 (S1), staff #2 (S2), staff #3 (S3), and obtained a copy of internal incident report and written statements from the staff. P1 was not available to interview. C1 and C2 are not able to interview due to the age of the children.

Director stated that the video was reviewed by management and did not find that C1 and C2 were handled inappropriately. LPA was unable to review video as it only is able to be viewed for the first 24 hours after the incident. S1 during interview did not disclose any appropriate mishandling of children after a detailed description. S2 did not disclose any mishandling of children or personal rights being violated. S3 was not available to interview on this day as they had gone home. Director stated that staff was interviewed after the incident and S1 was asked to review appropriate handling of children just as a precaution.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EVERBROOK ACADEMY, LLC
FACILITY NUMBER: 198020851
VISIT DATE: 02/24/2023
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There are no deficiencies being cited.

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.

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

DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023
LIC809 (FAS) - (06/04)
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