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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890344
Report Date: 05/23/2022
Date Signed: 05/23/2022 04:15:34 PM


Document Has Been Signed on 05/23/2022 04:15 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:EVERGREEN EARLY EDUCATION CENTERFACILITY NUMBER:
191890344
ADMINISTRATOR:XOCHITL SANCHEZFACILITY TYPE:
850
ADDRESS:1027 N EVERGREEN AVETELEPHONE:
(323) 269-0406
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY:162CENSUS: 58DATE:
05/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Xochitl Sanchez, Principal &
Miriam Villarreal, Teacher Assistant		TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Mireya García conducted an unannounced Case Management inspection due to an incident that was reported to the Department on March 18, 2022. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with Principal, Xochitl Sanchez who guided LPA on a tour of the facility. Census was taken.

On March 18, 2022, an incident was self reported to the Department via telephone by the facility who reported a parent alleges that child's personal rights were violated while in care. The purpose of the inspection was to obtain additional information regarding the allegation reported to the Department. During the inspection, LPA conducted interviews with Principal, three (3) staff and four (4) day care children. LPA was unable to complete interviews on this date. Due to insufficient information available at this time, a follow up visit will be required at a later date.


A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Teacher Assistant, Miriam Villareal.


END OF REPORT: PAGE 1 OF 1.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
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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