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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 12:51:25 PM


Document Has Been Signed on 05/23/2022 12:51 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:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Principal, Xochitl SanchezTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced Annual Required Inspection. LPA met with Principal, Xochitl Sanchez, who guided LPA on a tour of the facility indoors and outdoors. This is a preschool program which is operated by LAUSD. This program consists of 5 classrooms; RM1, RM2, RM3, RM4 and RM5. Facility operation hours are Monday through Friday from 7:00 AM to 5:30 PM. This facility has a capacity of 162 children; preschool children ages 2 through entry to Kindergarten.

Upon arrival, the following staff were present during this inspection: RM1: Staff #1, #2, #3 and #4 with 14 preschoolers; RM2: Staff #5, #6, #7 and #8, with 12 preschoolers, RM3: Staff #9, #10 and #11 with 11 preschoolers, RM4:Staff #12, #13, and #14, with 12 preschoolers and RM5: Staff #15, #16 and #17 with 9 preschoolers. Teacher-child ratio is met. All individuals present have obtained a criminal record clearance or criminal record exemption. All staff have received an active criminal record clearance as a condition of their employment with the Los Angeles Unified School District. All children were observed to be under visual supervision of a teacher at all times.


REPORT CONTINUES ON NEXT PAGE 1 OF 5.
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)
Page: 1 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: 05/23/2022
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LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. Indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, the staff lounge is used as an isolation area. There are chairs and a mat can be placed in the lounge. Per Principal, when weather permits there is also an isolation area outside that it being used. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted.

Food menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Preschoolers are provided with Breakfast, Lunch and PM Snack by the Los Angeles Unified School District. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. There are no trash cans with tight fitting lids in the classrooms. However, Principal states that trash is removed from the classroom/movable bins right after meal times. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Principal, Xochitl Sanchez states that there are no poisons stored at the facility.


REPORT CONTINUES ON NEXT PAGE 2 OF 5.
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
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
VISIT DATE: 05/23/2022
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Facility has one functioning carbon monoxide detector that meets statutory requirements. The carbon monoxide detector is located in the hallway area in between classrooms #1 and #2, which was tested at 9:29 am, and it is in operable condition. The facility representative takes measures to keep the facility free of flies, other insects and rodents.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The Principal states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit. Areas around and/or under climbing equipment and slides have soft cushioning to absorb a fall.

Sign in and out sheets were reviewed by LPA to ensure that children who are present where sign in. Staff Records were reviewed to ensure that personnel records are maintained on all staff. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. LPA issued the Children’s Record Review (LIC 857) and the Review of Staff records (LIC 859) to the Principal during this inspection. There is at least one person trained in Pediatric CPR and First Aid present during this inspection.


SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative.
REPORT CONTINUES ON NEXT PAGE 3 OF 5.
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
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: 05/23/2022
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AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

Incidental Medical Services (IMS) policy was discussed. 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. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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



The following was discussed:
  • Reporting Requirements.
  • The facility shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations.


REPORT CONTINUES ON NEXT PAGE 4 OF 5.
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
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: 05/23/2022
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The following was discussed continued:
  • All personnel shall be in good health and shall be physically and mentally capable of performing assigned tasks; personnel that pose a threat to the health and safety of children shall be relieved of their duties.
  • All personnel shall be given on the job training in housekeeping, sanitation principles and universal health precautions.

LPA advised the facility representative to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

At this time, there were no deficiencies cited during today’s inspection.

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



Exit interview conducted and report was reviewed with facility representative, Principal, Xochitl Sanchez.

REPORT ENDS HERE PAGE 5 OF 5.
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
LIC809 (FAS) - (06/04)
Page: 5 of 7