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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846072
Report Date: 10/31/2023
Date Signed: 10/31/2023 12:26:45 PM

Document Has Been Signed on 10/31/2023 12:26 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 ACADEMYFACILITY 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: 113CENSUS: 95DATE:
10/31/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Margaret Gale Van DuzerTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) made an unannounced collateral visit to conduct interviews with a child and staff pertaining to complaint 09-CC-20231006100448 filed for prior facility that the child attended. LPA met with the director, Margaret Van Duzer and explained the reason for the visit.

LPA conducted required interviews.

An exit interview was conducted and a copy of this report and a notice of site visit was given to the director, Margaret Gale Van Duzer.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2023
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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