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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890344
Report Date: 01/30/2024
Date Signed: 01/30/2024 10:24:22 AM


Document Has Been Signed on 01/30/2024 10:24 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
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: 59DATE:
01/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Xochitl Sanchez, Principal TIME COMPLETED:
10:35 AM
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Licensing Program Analysts (LPA's) Roxana Lopez and Saul Valenzuela conducted an unannounced Case Management Incident inspection. A COVID 19 risk assessment was conducted. LPAs met with Principal Xochitl Sanchez who guided LPAs on a tour of the facility. Prinicipal advised LPAs that they were in a training and Lead Teacher was out for the day. Census was taken.

The purpose of the inspection was to follow up on a unusual incident report which was reported to the department on 1/25/2024. LPAs obtained copies of facility roster and personnel report- follow up will be conducted at another time.



At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

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

Exit interview conducted and report was reviewed with the facility representative Office Manager Mayra Guzman.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2024
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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