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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021184
Report Date: 03/15/2024
Date Signed: 03/15/2024 11:48:43 AM

Document Has Been Signed on 03/15/2024 11:48 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:EVERGREEN CHILD CARE CENTERFACILITY NUMBER:
198021184
ADMINISTRATOR:SASHA DUARTEFACILITY TYPE:
850
ADDRESS:211 S. EVERGREEN AVENUETELEPHONE:
(323) 263-2816
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY: 46TOTAL ENROLLED CHILDREN: 46CENSUS: DATE:
03/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Sasha Duarte, Child Care DirectorTIME COMPLETED:
12:05 PM
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Licensing Program Analysts (LPA) Staicy Perry conducted an unannounced case management inspection. Upon arrival at 8:00am facility seemed to be closed. LPA called facility, no answer. LPA then seen teacher arrive to facility and teacher Leslie granted LPA access to facility and stated that children arrive at 9:00am. Shortly after LPA met with Sasha Duarte, Child Care Director. Sasha Duarte, Child Care Director guided LPA on a tour of the facility. The purpose of the inspection was to obtain additional information from the facility regarding an incident reported to the regional office. Census was taken. LPA observed 3 children and 4 staff at the time of inspection. This is a preschool program and Hours of Operation are Facility operates M-F from 9:00am-12:00pm. .

The department received an incident report via email from this facility on 03/12/2024 for an incident that occurred at the facility on 03/12/2024 involving an incident with an injury while in care. Report was received to the department in a timely manner.

During the inspection LPA conducted (2) staff interviews and (1) child interview regarding the incident. LPA obtained documentation in the form of facility roster, incident report that was provided to the parent, parent handbook, personnel report, child's emergency card and sign in and out sheet for March 12,2024.

During the visit LPA Perry observed the Monkey Bars located in the main play yard where C#1 fell from (pictures were taken). LPA did observe all the classrooms in today’s inspection. Based on manufactures information, it was determined that climbing structure is age appropriate. Manufacture label discloses that the structure is from ages 2-5 years old. After interviews were conducted it was determined that supervision was present and S#1 and S#2 did observe C#1 fall from the monkey bars. Through interviews it was disclosed that proper steps were taken to assist child.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
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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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: 03/15/2024
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Based on all information obtained on this date, and interviews conducted with Center Director,staff and child, no follow-up is necessary regarding the incident. The incident appears to be an unusual accident. It appears to be nothing the facility staff could have done to prevent the incident from occurring. There were no deficiencies observed in regards to today's visit.

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Exit interview conducted with Sasha Duarte, Child Care Director and report provided. Appeal rights discussed and explained.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC809 (FAS) - (06/04)
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