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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890344
Report Date: 06/13/2023
Date Signed: 06/13/2023 11:19:41 AM


Document Has Been Signed on 06/13/2023 11:19 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 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: 40DATE:
06/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Xochitl Sanchez, PrincipalTIME COMPLETED:
11:30 AM
NARRATIVE
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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 April 03, 2023. LPA met with Principal Xochitl Sanchez who guided LPA on a tour of the facility. Census was taken.

On April 03, 2023, 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 obtained a copy of the LIC 9040 Children's roster dated 06/13/23 and conducted interviews with Principal, four (4) day care children and telephone interview with Parent #1. 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, Xochitl Sanchez. 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: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023
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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