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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371532
Report Date: 08/15/2024
Date Signed: 08/15/2024 04:00:21 PM

Document Has Been Signed on 08/15/2024 04:00 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:EVERBROOK ACADEMYFACILITY NUMBER:
304371532
ADMINISTRATOR/
DIRECTOR:
JOHNSON, SANDRAFACILITY TYPE:
850
ADDRESS:16498 ROYAL OAKTELEPHONE:
(949) 559-6810
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 195TOTAL ENROLLED CHILDREN: 195CENSUS: 58DATE:
08/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Sandra Johnson, Director TIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Patricia Duron conducted an unannounced case management investigation for the incidents which the facility self reported to licensing office on 08/09/24. The unusual incident report stated an unusual incident occurred at the facility on 8/5/24 and 8/8/24. The Director stated On 8/5/24, Child 1 (C1) was left inside the classroom, Staff 1(S1) observed movement inside the classroom and informed Staff 2 (S2). S2 opened the classroom door and C1 came out with rest of the class.

The Director stated on 8/8/24, Child 2 (C2) was outside by themselves when Staff 3 (S3) came outside and observed C2 running towards S3. S3 informed the Director and the Director brought C2 back to their room. The Director stated S4 and S5 were checking Face to Name form and realized C2 was missing when the Director brought C2 back to the classroom.

Upon arrival LPA, was met by Director Sandra Johnson, LPA explained the reason for today's visit. Director Johnson provided a tour of the facility. LPA observed 9 preschool staff and 58 preschool children in care during today’s visit.

A review of facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During today's inspection, LPA Duron interviewed 2 staff, and review files (children and staff) LPA obtained facility roster.

Due to insufficient information available at this time, case management needs further investigations.

An exit interview conducted with Director, Sandra Johnson. The Director was provided a copy of appeal rights (LIC 9058 ) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

Notice of Site Visit was provided and posted. Notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. End of Report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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