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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846072
Report Date: 12/15/2022
Date Signed: 12/15/2022 01:44:04 PM

Document Has Been Signed on 12/15/2022 01:44 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:EVERBROOK ACADEMY, LLC DBA PRESTIGE PRESCH ACADFACILITY NUMBER:
364846072
ADMINISTRATOR:VAN DUZER, MARGARET GALEFACILITY TYPE:
850
ADDRESS:3040 CHINO AVETELEPHONE:
(909) 591-7574
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY: 168TOTAL ENROLLED CHILDREN: 106CENSUS: 88DATE:
12/15/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Gale Van DuzerTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Rachel Zeron arrived at the facility to conduct an unannounced visit and met with the Director, Gale Van Duzer. LPA toured the facility and took census.

During a record review, Licensing Program Analyst (LPA) Rachel Zeron, it was revealed that a child has bitten numerous children in care. Interviews with staff confirmed that incidents of biting were observed and written up on an incident report. Over the course of five months, June 2022 -October 2022, DIrector had numerous verbal conversations with the responsible party, with no improvement in the behaviors of Child 1 (C1). The facility did not have a written plan of disciplinary action to address the behaviors.

During the investigation, it was also revealed that 9 bites had occurred over this time period involving staff and children. While the facility attempted to accommodate C1 by providing additional supervision, incidents continued to occur. Therefore, The facility is in violation of personal rights for the children, to be accorded safe, healthful and comfortable accommodations.

Director indicated that the child is no longer attending the facility, after a discussion was had with responsible party regarding behavior.

See LIC809D for cited deficiencies. Appeal rights were discussed and a copy was provided.

An exit interview was conducted and a copy of this report was provided this date.

A notice if site visit was given and is required to be posted for the next 30 days
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2022
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 2
Document Has Been Signed on 12/15/2022 01:44 PM - It Cannot Be Edited


Created By: Rachel Zeron On 12/15/2022 at 09:49 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: EVERBROOK ACADEMY, LLC DBA PRESTIGE PRESCH ACAD
FACILITY NUMBER: 364846072

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/29/2022
Section Cited
CCR
101223(a)(2)

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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights:
To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
The requirement was not met as evidenced by:
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Director agreed to have a plan of action for future behaviors to ensure the safety of children in care. Plan is due by POC date.
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Based on interviews conducted and records review, Child 1 (C1) had bitten multiple children in care over a course of 5 months and the facility did not have a behavioral plan in place for C1. Facility failed to provide a safe environment for the children in care. This poses a potential health, safety or personal rights risk to persons in care.
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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.
SUPERVISOR'S NAME:Aaron Ross
LICENSING EVALUATOR NAME:Rachel Zeron
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022


LIC809 (FAS) - (06/04)
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