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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371532
Report Date: 01/21/2025
Date Signed: 01/21/2025 12:47:04 PM

Document Has Been Signed on 01/21/2025 12:47 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:EVERBROOK ACADEMYFACILITY NUMBER:
304371532
ADMINISTRATOR/
DIRECTOR:		DE LA TORRE, KATHERNFACILITY TYPE:
850
ADDRESS:16498 ROYAL OAKTELEPHONE:
(949) 559-6810
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 195TOTAL ENROLLED CHILDREN: 195CENSUS: 56DATE:
01/21/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Director DE LA TORRE, KATHERNTIME VISIT/
INSPECTION COMPLETED:
01:00 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 1/21/2025 at 9:00AM, Licensing Program Analyst (LPA), Christine Jung, conducted an unannounced case management-deficiency inspection to follow up on an incident that was self-reported to the Department. Upon arrival, LPA met with Director, Kathern De La Torre. LPA disclosed the purpose of the inspection and was led on a tour of the facility. There were 56 children and 12 staff members present.

The facility submitted an unusual incident report (UIR) to the Department on 1/15/2025 reporting an incident surrounding Child 1 (C1). The facility reported that on 1/14/2025, C1 exited the classroom’s back door which led to a play yard. C1 was discovered by Staff 1 (S1) who saw C1 from a different exit door of the facility. S1 notified Staff 2 (S2) regarding C1’s position, and S2 walked C1 back to their classroom.

Interviews were conducted with four (4) staff members. LPA reviewed camera footage of classroom and play yard and took photos of the classroom and play yard.

Staff interviewed revealed that the back door of the classroom had been propped open for ventilation. The opening was barricaded by one of the children’s play furniture. This play furniture has a gap at the bottom which C1 crawled through and exited the room toward the play yard where they were seen by S1.

The Facility staff reported the incident to the Department in a timely manner. Based on the information obtained and interviews conducted, one Type A citation for Lack of Supervision is being cited on LIC 809D.

LPA Jung informed Director Kathern De La Torre that this report dated 1/21/2025 documents one (1) Type A citation. Type A citation shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

(Go to Page 2)
SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: EVERBROOK ACADEMY
FACILITY NUMBER: 304371532
VISIT DATE: 01/21/2025
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
(Page 2)
Also, LPA Jung informed the Director Kathern De La Torre to provide a copy of this licensing report dated 1/21/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted with Director Kathern De La Torre.

Notice of Site Visit (LIC9213) was provided and shall be posted for 30 days.

End of report.
SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/21/2025 12:47 PM - It Cannot Be Edited


Created By: Soo Jin Jung On 01/21/2025 at 11:19 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: EVERBROOK ACADEMY
FACILITY NUMBER: 304371532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2025
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
101229(a)(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Director stated that the facility has decided to no longer prop open doors for ventilation unless all children are moved to a different classroom. Director stated they will provide staff training documents with signatures and email them to LPA by due date.
8
9
10
11
12
13
14
Based on interviews and record review, the licensee did not comply with the section cited above in that, Child 1 (C1) was in the play yard alone without teacher supervision, which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nguyen K Tran
LICENSING EVALUATOR NAME:Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:
DATE: 01/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/21/2025


LIC809 (FAS) - (06/04)
Page: 3 of 3