364846073-10-31-2023-09-CC-AROS-CZARXT-20240108122517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 364846073
Report Date: 10/31/2023
Date Signed: 10/31/2023 12:23:48 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2023 and conducted by Evaluator Rachel Zeron

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20231006100833

FACILITY NAME:	EVERBROOK ACADEMY		FACILITY NUMBER:	364846073
ADMINISTRATOR:	VAN DUZER, MARGARET GALE		FACILITY TYPE:	830
ADDRESS:	3040 CHINO AVE		TELEPHONE:	(909) 591-7574
CITY:	CHINO HILLS	STATE: CA	ZIP CODE:	91709
CAPACITY:	28	CENSUS: 23	DATE:	10/31/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Margaret Gale Van Duzer		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff did not follow infant's feeding plan

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rachel Zeron made an unannounced visit to the facility continue the investigation and delivered findings for a complaint that was filed on 10/11/2023. LPA met with Margaret Gale Van Duzer, DIrector . The following was alleged: Staff did not follow infant's feeding plan . LPA reviewed records/documents, interviewed pertinent individuals and made direct observations. On this visit, Additional interviews and a tour of the facility was conducted.

On 10/13/2023, LPA made a unannounced visits to the facility to conduct interviews and collect pertinent documentation. Interviews revealed that on the date in question, 10/05/2023, Infant 1(I1) was dropped of by I1's responsible party (RP) and I1's bottles and lunch was placed in the refrigerator by the RP. According to interviews and observation, each infant has a plastic tub in the refrigerator with the infants name on it, this is where the infants bottles and food for each day is placed. On that particular day, 10/05/2023, the RP placed I1's bottles in the plastic tub but placed the solid food on the bottom shelf of the refrigerator.

Unsubstantiated

Estimated Days of Completion:

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.

LIC9099 (FAS) - (06/04)

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Control Number 09-CC-20231006100833

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: EVERBROOK ACADEMY	FACILITY NUMBER: 364846073
	VISIT DATE: 10/31/2023

NARRATIVE

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Staff indicated that they did not see the solid food Tupperware and proceeded to give I1 puree, which is the back up if no food is brought for that day. RP immediately called the Director and indicated that RP seen the teacher on the camera in the classroom give I1 puree instead of the solid food that was in the refrigerator. I1 had already completed the pureed food, the solid food was not given on that day. Upon review of the infant feeding plan, it was stated that "around 12pm" solid food is to be given to I1. Based on the miscommunication between staff and the RP about the food being placed in a different location, this allegation is UNSUBSTANTIATED at this time.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

A NOTICE OF SITE VISIT WAS GIVEN. DIRECTOR WAS INSTRUCTED TO POSTED IT IN A PROMINENT LOCATION AT THE FACILITY. THE DIRECTOR UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.
An exit interview was conducted, A copy of this report were given to the Director, Margaret Gale Van Duzer during this visit.

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

LIC9099 (FAS) - (06/04)

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