304370328-8-13-2019-06-CC-JHAN-BGEMSC-20190927095142

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304370328
Report Date: 08/13/2019
Date Signed: 08/13/2019 05:42:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/25/2019 and conducted by Evaluator Gesine Connolly

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20190625170227

FACILITY NAME:	EVERBROOK ACADEMY		FACILITY NUMBER:	304370328
ADMINISTRATOR:	LARSON, RUTH		FACILITY TYPE:	830
ADDRESS:	30722 RICHARD REESE WAY		TELEPHONE:	(949) 888-7274
CITY:	RANCHO SAN MARGARITA	STATE: CA	ZIP CODE:	92688
CAPACITY:	32	CENSUS: 16	DATE:	08/13/2019
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Ruth		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Facility staff fed day-care child breast milk that belonged to another child.
Facility staff using inappropriate infant equipment.

INVESTIGATION FINDINGS:

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A subsequent complaint inspection was made today by Licensing Program Analyst (LPA) Connolly. At the time of arrival the LPA met with the director, Ruth Larson, who accompanied the LPA on a tour of the infant center. Census was taken. There were 16 infants in care with four attending staff.
A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances.

This subsequent complaint inspection is being made due to the above allegations received in the licensing office on 6/25/19. The prior complaint inspection was made 7/3/19.
The director was informed that during the course of this investigation four staff have been interviewed. The facility has provided a copy of infant and staff attendance sheets for two weeks of the month June 2019 and a copy of a self reported incident in which an infant in care was provided with another infant's bottle. These copies have all been reviewed. continued on page two

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20190625170227

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: EVERBROOK ACADEMY	FACILITY NUMBER: 304370328
	VISIT DATE: 08/13/2019

NARRATIVE

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The allegation facility staff fed day-care child breast milk that belonged to another child is a duplication of an allegation received in the licensing office 6/17/19. This allegation has been addressed on a complaint investigation report dated 8/13/19.

The allegation facility staff are using inappropriate infant equipment in that children are being placed in chairs that are not appropriate for the babies is found to be unsubstantiated. The infant equipment observed and researched by the LPA has been found to be age appropriate for ages served in the infant center.

The director was informed that based upon the LPA's observations and research and based upon staff interviews and record reviews there is not a preponderance of evidence to either support or negate this complaint allegation. The allegation is therefore determined to be unsubstantiated.

No deficiencies are cited.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) 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 the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result civil penalties of $100.00. The 'Notice of Site Visit' must be posted on or adjacent tot he door.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC9099 (FAS) - (06/04)

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