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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304371533
Report Date: 09/26/2022
Date Signed: 09/26/2022 03:24:58 PM

Substantiated


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
04/14/2022 and conducted by Evaluator Dianna ValdezSantana
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20220414095950
FACILITY NAME:EVERBROOK ACADEMYFACILITY NUMBER:
304371533
ADMINISTRATOR:WELCH, AMBERFACILITY TYPE:
830
ADDRESS:16498 ROYAL OAKTELEPHONE:
(949) 559-6810
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY:30CENSUS: 14DATE:
09/26/2022
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Director, Joelle Courtney TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Administrator spoke inappropriately in front of daycare children.
INVESTIGATION FINDINGS:
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On 9/26/22, Licensing Program Analyst (LPA) Dianna Valdez Santana and Licensing Program Manager (LPM) Thuy Ho conducted an unannounced visit to deliver the amended finding regarding the above complaint allegation.
LPA Valdez Santana and LPM Ho met with director, Joelle Courtney and toured the facility. The Covid-19 Emergency Response questionnaires were asked.
There was a total of 5 staff and 14 children were 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 04/14/2022, the office received a complaint and the complainant reported that while staff #5 (S5) reminded a parent about the late tuition, S5 showed disrespectful behavior and spoke inappropriately toward the parent in front of daycare children.
LPA Nguyen & LPM Ho reviewed the videos, the videos depicted the engagement/conversation between S5 and the Parent #1, should be noted Parent #1 had their child present with them.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 06-CC-20220414095950
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: 09/26/2022
NARRATIVE
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In the video, S5 was seen inappropriately talking to the Parent #1. S5’s body language depicted S5 raising both hands in the air and S5 tone of voice was that of an angry voice when S5 spoke to Parent #1. In fact, S5 raised voice their voice to Parent #1 stated “Good. Go ahead and record me. Where? Who will have me on the record? Bitch.” Another video depicted S5 said “Goodbye” to the Parent #1 in a very rude way as S5 walked away from the parent into the office.

S2 was present during the incident between S5 and the Parent #1 on 4/15/2022. S2 stated, S5 reminded the Parent #1 to pay for the tuition since it was already late, and the Parent #1 was upset with S5. S2 confirmed that S5 was talking to the Parent #1 inappropriately and it was very abnormal for S5 to behave that way towards any parent in front of the children.

District Manager (DM) stated they had not seen the video recording of the incident with S5 talking inappropriately to Parent #1. DM talked to S2 after the incident happened on 4/15/2022 and S2 advised DM that S5 was reminding Parent #1 to pay for the tuition and the Parent #1 began to yell at S5. Since 4/15/2022 was S5’s last day of employment at the facility, DM did not have time to address the inappropriate behavior of S5 towards Parent #1. DM stated the Parent #1 never took the child back to the facility after 4/15/2022.

Based on LPA’s interview and reviewing the videos, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Chapter 1, 101223(a)(1) Personal Rights is being cited on the attached LIC9099D

Exit interview was conducted. The Notice of Site Visit was posted. Director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. “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.”.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 06-CC-20220414095950
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2022
Section Cited
CCR
101223(a)(1)
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Personal Rights: The licensee shall ensure that each child is accorded the
following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as evidence by:
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 DIrector stated she will condcut a "Personal Rights" training with staff and send LPA via email to dianna.valdezsantana@dss.ca.gov a copy of the staff sign in sheet and meeting agenda.
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Based on video and Staff statement of inappropriate behavior of S5 talking inappropriately and disrespectful toward the parent in front of the child.


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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3