198021184-9-5-2023-33-CC-CGRN-CVDRDD-20230905125546

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021184
Report Date: 09/05/2023
Date Signed: 09/05/2023 12:56:17 PM

Document Has Been Signed on 09/05/2023 12:56 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	EVERGREEN CHILD CARE CENTER		FACILITY NUMBER:	198021184
ADMINISTRATOR:	GONGORA, SASHA		FACILITY TYPE:	850
ADDRESS:	211 S. EVERGREEN AVENUE		TELEPHONE:	(323) 263-2816
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90033
CAPACITY: 50	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/05/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sasha Gongora		TIME COMPLETED:	01:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An announced pre-licensing site inspection was conducted today by Licensing Program Analysts (LPAs) Crystal Green and Elka Chavez to inspect and measure facility for capacity determination. Licensing staff met with Director, Sasha Gongora, and LaShon Tillie Jones, Child Care Program Manager. The applicant is requesting to operate a Preschool Program. This proposed Preschool Program will operate from Monday through Friday from 7:00 AM until 6:00 PM. LPAs were provided a tour of the facility. This facility will have two classrooms (Room 116 and Room 117) and a library. The classrooms will be called Classroom A (Room 117) and Classroom B (Room 116). LPAs observed a total of 4 toilets and 4 sinks accessible to the preschool children. All toilets and sinks are in safe and sanitary operating conditions. Furniture and equipment were inspected for age appropriateness and good repair. Individual storage space was observed located within each classroom. All classrooms were observed to contain storage area for children's cots. Drinking water will be available to children via water igloos and disposable cups and their personal sippy cups. There are smoke detectors and fire extinguishers located throughout the premises. The isolation area for an ill child will be located next to the Directors office. There is also a fully equipped first aid kit and a locking medication cabinet located in the main office. This facility has a kitchen on site that will be used to prepare snacks and lunch. Children will not have access to the kitchen area. All kitchen, food preparation, and storage areas were observed to be clean, free of litter, rubbish, and rodents. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. No transportation will be conducted by the facility. Report Continues Page 1 of 3

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: EVERGREEN CHILD CARE CENTER	FACILITY NUMBER: 198021184
	VISIT DATE: 09/05/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Licensing staff was guided through the outdoor space. The designated outdoor play area was observed to be fully enclosed by a fence. LPAs observed the outdoor area to contain picnic tables, climbing play structure, and age-appropriate toys and equipment. There is adequate shade provided in the outdoor play area.

Applicants was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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

Applicants was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). This facility has completed testing and the results has been received by the department. Results indicate that 1 water source had action level exceedance of lead. The sink bubbler (sample G) located in the classroom A (room 117). The facility has completely removed the bubbler from the sink to prevent children from accessing the faucet. LPA Green obtain pictures of the correction.

Report Continues Page 2 of 3

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: EVERGREEN CHILD CARE CENTER	FACILITY NUMBER: 198021184
	VISIT DATE: 09/05/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The Department has received an approved Fire Clearance from the Los Angeles City Fire Department. LPAs obtained measurements during this inspection. The outdoor space can accommodate 50 children however the indoor space can only accommodate 46 children. The applicant has requested to provide care for 50 children however due to the measurements obtained for the indoor capacity the facility capacity will be for 46 children.

The applicant has conducted lead testing on the water faucets at the facility. LPAs observed the water bubblers to be removed from the faucets located in classroom A.

The following correction will need to be made before receiving final approval. Correction will be due by 9/15/2023.

• The Applicant will submit proof of the installing (3) door chimes or notifications on the doors that lead into the outdoor space.

An exit interview was conducted with Facility Representatives and a signed copy of this report was provided.

Report Ends Page 3 of 3

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3