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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371533
Report Date: 08/22/2022
Date Signed: 08/22/2022 03:05:09 PM

Document Has Been Signed on 08/22/2022 03:05 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:
304371533
ADMINISTRATOR:COURTNEY, JOELLEFACILITY TYPE:
830
ADDRESS:16498 ROYAL OAKTELEPHONE:
(949) 559-6810
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 12DATE:
08/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Director Joelle CourtneyTIME COMPLETED:
02:50 PM
NARRATIVE
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On 08/22/2022, Licensing program analyst (LPA) Nguyen was to conduct a Case Management Evaluation of the facility. LPA Nguyen met with the director Joelle Courtney and toured the facility inside and outside. Census was taken in individual classrooms. The overall census observed was 4 staff members and 12 children. A review of staff criminal clearance records 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.

The reason of the visit today is to obtain additional information regarding to the incident occurred at the facility on 04/15/2022

During today’s inspection, staff interviews was conducted. LPA obtained the supportive documents.

After a tour of the facility, no deficiency observed.

Hard copy and link of Child Care Providers Guide to Safe Sleep provided to licensee on this day: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

During exit interview, “The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.” Notice of Site Visit was posted. Licensee was informed to keep the Notice of Site Visit posted for 30 days during the day care hours or $100 civil penalty will be assessed.

Web address for downloading forms or regulations was provided as (http://ccld.ca.gov/PG411.htm).
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2022
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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