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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890344
Report Date: 07/17/2019
Date Signed: 07/17/2019 03:02:45 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:EVERGREEN EARLY EDUCATION CENTERFACILITY NUMBER:
191890344
ADMINISTRATOR:KARLA CORONAFACILITY TYPE:
850
ADDRESS:1027 N EVERGREEN AVETELEPHONE:
(323) 269-0406
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY:162CENSUS: 86DATE:
07/17/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Karla Corona, PrincipalTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mireya García conducted an unannounced annual/required inspection. LPA met with Karla Corona, Principal, who guided analyst on a tour of the facility. This is a preschool program which consists of 5 classrooms; RM 1, RM 2, RM 3, RM 4, and RM 5. Facility operation hours are Monday through Friday from 7:00 AM to 5:30 PM.

All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection: RM 1: Staff #1, #2, and #3, with 14 preschoolers; RM 2: Staff #4, #5, #6 and #7 with 15 preschoolers, RM 3: Staff # 8, #9, and #10 with 20 preschoolers, RM 4: Staff # 11, #12, and #13 with 18 preschoolers, RM 5: Staff #14, #15, and #16 with 19 preschoolers. The following was observed during the tour of the facility:

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SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: EVERGREEN EARLY EDUCATION CENTER
FACILITY NUMBER: 191890344
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2019
Section Cited
HSC
1596.954
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1596.954- Carbon monoxide detectors required; inspection:

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.
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During LPA's visit Principal order 2 carbon monoxide detectors and provided LPA with the proof of purchase online order. Per Principal she will have carbon monoxide detectors installed and will take pictures upon installation and will submit to LPA, Garcia via email by POC due date 07/18/2019.
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This requirement is not met as evidenced by LPA observation and interview with Principal who informed LPA that they did not have any carbon monoxide detector in the premises. This poses an immediate risk to the health and safety of children 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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: EVERGREEN EARLY EDUCATION CENTER
FACILITY NUMBER: 191890344
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2019
Section Cited
CCR
101238(a)
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101238 Buildings and Grounds : (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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During LPAs visit LPA observed all electrical outlets covered in RM 5, RM 4, RM 2 and RM 1. Per Principal this is an reoccuring problem with staff assuring that electrical outlets are being covered after uncovering them for use. Principal will meet with all staff to re-address this matter and will send LPA, Garcia meeting agenda/sign in sheet by POC due date of 07/31/2019.
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This requirement is not met as evidenced by LPAs observation and interview with Principal RM 5, RM 4, RM 2 and RM 1 were missing electric outlet covers during the inspection. This poses a potential risk to the health and safety of children 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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EVERGREEN EARLY EDUCATION CENTER
FACILITY NUMBER: 191890344
VISIT DATE: 07/17/2019
NARRATIVE
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Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. LPA García advised Principal Karla Corona that the children need to be within the direct care and supervision, including visual supervision, of the teacher(s) and supervising staff at all times. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed.

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. The name of the child care center director or fully qualified teacher(s) designated to act in the director's absence is on file. Educational background, training, and/or experience for each staff present are on file and were reviewed.

Staff and Children’s Records were reviewed for completeness; in review of staff records, LPA observed that immunization records for Staff #4 and #11 were not provided or available for review. File's are available to view at District office. Inspection of required forms was made. LPA issued the Children’s Record Review (LIC 857) and the Review of Staff records (LIC 859) to the Principal during this inspection.

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SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EVERGREEN EARLY EDUCATION CENTER
FACILITY NUMBER: 191890344
VISIT DATE: 07/17/2019
NARRATIVE
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LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. UPDATE: Earthquake preparedness checklist (LIC 9148) was provided to the Principal during this inspection. LPA advised licensee of the Mandated Reporter Child Care Training that became in effect January 1, 2018, and to maintain a copy of the certificate on file for each staff.

The following deficiencies listed on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee/Director.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Karla Corona, Principal, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. Page 5 of 5.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EVERGREEN EARLY EDUCATION CENTER
FACILITY NUMBER: 191890344
VISIT DATE: 07/17/2019
NARRATIVE
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In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

Children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on June 12, 2019.

Monthly food menus are posted where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Lunch was reviewed for availability, quantity and appropriateness to children in care. Preschoolers are provided with breakfast, lunch, and p.m., snack by the Los Angeles Unified School District.

First Aid supplies were observed in each classroom in the closets. According to the Principal, medication is only administered to a child when accompanied with a doctor's note and is stored in the locked cabinet in the staff lounge.

Medication: This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm Page 4 of 5

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EVERGREEN EARLY EDUCATION CENTER
FACILITY NUMBER: 191890344
VISIT DATE: 07/17/2019
NARRATIVE
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PHYSICAL PLANT
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Linens are washed weekly by the school district. Napping equipment (mats) were observed in a separate storage room or designated storage area in each classroom. LPA did observe that RM 5, RM 4, RM 2 and RM 1 were missing electric outlet covers during the inspection. Per Principal, the isolation area is located in the staff lounge. In the staff lounge a mat can be placed on the floor for an ill child and the staff restroom is readily available if an ill child requires it. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. LPA observed that the facility does not have a carbon monoxide detector. General sanitation was observed. Availability of indoor drinking water was observed in each classroom.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children in all areas. Principal Karla Corona states that there are no poisons stored at the facility.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids.

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SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 7 of 7