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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370328
Report Date: 07/01/2019
Date Signed: 07/01/2019 11:51:43 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:EVERBROOK ACADEMYFACILITY NUMBER:
304370328
ADMINISTRATOR:LARSON, RUTHFACILITY TYPE:
830
ADDRESS:30722 RICHARD REESE WAYTELEPHONE:
(949) 888-7274
CITY:RANCHO SAN MARGARITASTATE: CAZIP CODE:
92688
CAPACITY:32CENSUS: 11DATE:
07/01/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:DirectorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an inspection of this program today. The purpose of the inspection was to make sure that this program is in compliance with Title 22 Regulations. LPA met with director, Ruth Larson. Census was taken. There were a total of 11 infants and toddles with 3 staff observed in two different rooms. There were 4 awake infants with one staff, and 3 infants with one staff in the crib area in the infant room. Toddler room 1 was not in use. There were 4 toddlers outside with one staff from Toddler room 2. A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Equipment and furniture was inspected to ensure it's in good condition, free of sharp, loose or pointed parts. The bins had tight fitting covers. The napping area is separated from the activity are and has sufficient infant napping equipment. There is no walkers on the premises. The changing table is within the arm's reach of a sink. Bottles and dishes are labeled with the current date and children's names. The infants and toddlers were being supervised in the awake area. There are no weapons, firearms or bodies of water in the facility. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material around and under high climbing equipment. Staff's files and a sample of children's files were reviewed for completeness of medical assessment, and verification of sign in/out including time the child was signed in/out. Immunization and Mandated Reporter Training Certificates for staff reviewed. The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The licensee was provided a copy of their appeal right (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the quarterly updates. Exit interview was conducted. In the areas that were evaluated, the facility was in compliance of the California Code of Regulations, Title 22, Division 12. No deficiency was cited today.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2019
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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