304371533-7-12-2022-06-CC-THOO-CGCR3M-20220715124009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304371533
Report Date: 07/12/2022
Date Signed: 07/12/2022 11:06:29 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/25/2022 and conducted by Evaluator Tina Nguyen

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20220425163840

FACILITY NAME:	EVERBROOK ACADEMY		FACILITY NUMBER:	304371533
ADMINISTRATOR:	WELCH, AMBER		FACILITY TYPE:	830
ADDRESS:	16498 ROYAL OAK		TELEPHONE:	(949) 559-6810
CITY:	IRVINE	STATE: CA	ZIP CODE:	92618
CAPACITY:	30	CENSUS: 7	DATE:	07/12/2022
		UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Assistant director Sandra Johnson Director Joelle Courtney		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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A staff caused child to have bruise/thumbprint

INVESTIGATION FINDINGS:

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On 07/12/2022, Licensing Program Analyst (LPA) Tina Nguyen conducted an unannounced visit to deliver the findings regarding the above complaint allegations. This complaint investigation had been started on 04/14/2022 by LPA Tina Nguyen. LPA Nguyen met with Assistant director Sandra Johnson. Director Joelle Courtney came after. LPA Nguyen touted the facility. The Covid-19 Emergency Response questionnaires were asked.

There was a total of 7 children with 4 staff observed during the inspection. A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 04/25/2022, our office received a complaint, and the complainant reported that A staff caused a child to have bruise/thumbprint on the arm. The complainant noticed bruise/thumbprint (the shape was an adult size) on child on 03/04/2022. No photo of the mark was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20220425163840

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: EVERBROOK ACADEMY	FACILITY NUMBER: 304371533
	VISIT DATE: 07/12/2022

NARRATIVE

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During the investigation, LPA interviewed 4 staff members and no disclosures were made by any staff member. All interviewed staff members stated they have never witnessed any staff caused any bruise to any child nor observing any thumbprint on any child. Staff #1 indicated the following: if children got hurt at the facility, teachers will fill out incident reports. If it is the head, the facility will call parents. For something serious, the facility would provide insurance for parents to take with the child to the hospital; also call 911 as need; the incident report would be completed and provided to the parents. If the facility notices any bruising or unusual marks on children body, the facility will document it on the incident report. If the children arrive with a bruise or mark and it looks suspicious or unusual, the facility would call Children protect services and Licensing to report it. All Interview staff indicated that if the child get hurt at the facility, they will complete incident report, talk to parents about the incident, and contact Licensing office. Interviewed staff acknowledged that they are mandated reporter, so if they see unusual marks on children body, they will need to report to Children protective services. The video footage during the time of incident occurred was not available anymore for LPA to review.

LPA Nguyen contacted five parents by phone and was able to interview two parents. All two interviewed parents stated they like the facility and all staff members are very nice, friendly, and professional. Interviewed parents also stated they did not have any concern or issue with the facility; Interviewed parents never witnessed any staff member handling children roughly.
LPA Nguyen also conducted an interview with 4 children. However, children were too young and not qualified for an interview.

Based on the information gathered from LPAs' interviews and reviewing records, there is insufficient evidence to corroborate the allegation of A staff caused child to have bruise/thumbprint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged A staff caused child to have bruise/thumbprint did or did not occur, therefore the allegations are UNSUBSTANTIATED.
Exit interview was conducted. The Notice of Site Visit was posted. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided. First level appeal is to Regional Manager, address is above on the report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

LIC9099 (FAS) - (06/04)

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