198021184-8-16-2024-33-CC-SPEY-D87U2H-20240816151157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021184
Report Date: 08/16/2024
Date Signed: 08/16/2024 03:12:25 PM

Document Has Been Signed on 08/16/2024 03:12 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/ DIRECTOR:	SASHA DUARTE		FACILITY TYPE:	850
ADDRESS:	211 S. EVERGREEN AVENUE		TELEPHONE:	(323) 263-2816
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90033
CAPACITY: 46	TOTAL ENROLLED CHILDREN: 4	CENSUS: 0	DATE:	08/16/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:15 PM
MET WITH:	Sasha Duarte, Director		TIME VISIT/ INSPECTION COMPLETED:	03:25 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	On, August 16, 2024, Licensing Program Analyst (LPA) Staicy Perry conducted an unannounced annual inspection and met with Sasha Duarte, Director who guided LPA Perry on a tour of the facility. This is a preschool program serving 46 children ages 2 to 6 years old. The facility operates Monday – Friday from 8:30 AM – 5:00 PM. Per Sasha, there are 4 children currently enrolled. Census was taken and LPA Perry observed 0 children and 0 staff present. LPA Perry began facility tour. All areas identified on the facility sketch were inspected. The facility is within the conditions, limitations, and capacity specified on the license. LPA Perry entered classroom A. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts. LPA Perry did observe age-appropriate toys accessible to children. LPA observed a cubby for children to store their personal belongings. LPA observed cleaning solutions stored inside the cabinet making it inaccessible for children to reach via a lock. LPA observed a library area that is in between the two classrooms. LPA Perry entered classroom B. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts. LPA Perry did observe age-appropriate toys accessible to children. LPA observed a cubby for children to store their personal belongings. LPA observed cleaning solutions stored inside the cabinet making it inaccessible for children to reach via a lock. Kitchen area is off limits to the children in care. LPA Perry observed a step trash bin with lids around the classrooms. LPA did observe cameras in the entrance way as well as in the play yard, classroom, and parking lot. LPA was advised that facility does not have access to video footage. Heating, lighting, and ventilation were evaluated by LPA Perry. LPA observed central AC/heater and vents located on the ceiling. LPA observed the thermostats located in classrooms and temperatures to be at 72-73 degrees. LPA observed the fire extinguishers located throughout the building and the valve on the required 2A10BC fire extinguishers indicating fully charged and serviced on 01/11/24. Smoke detectors were observed

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

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: 08/16/2024

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to be operating and is hard wired. Carbon monoxide detectors were observed to be in classrooms and was tested and is operable. The last emergency drill was conducted on 7/2/24. LPA observed napping equipment to be in the form of cots to be in good condition and stored in the classroom. First aid kit supplies are kept inside the classroom and LPA observed the kits to be fully equipped. During this visit, Sasha stated that currently no children are with medication or severe food allergies. Sasha stated no firearms, weapons, no poisons nor bodies of water. LPA did not observe firearms or weapons, poisons, nor bodies of water. Sasha stated the ill isolation area takes place right next to directors’ office with a blue cot and children will utilize the nearest staff restroom.

LPA Perry observed the restrooms to be in good condition with working toilets and sink. LPA observed hand soap dispenser and paper towels.

LPA Perry entered the outdoor play area. The outdoor play area was observed to be fully enclosed by a fence. LPA 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. LPA Perry observed the climbing structure equipment to be age appropriate with a manufactures label for ages 2-5 years of age. LPA observed the play structure to be free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. For adequate shade, LPA Perry observed a shade cover. LPA observed the playground yard to be fenced. LPA observed trash bins with tight lids. For outdoor water drinking, staff bring out water jugs and disposable cups.

This program provides lunch due to children arriving to facility at 9:00am. Meals are provided by facility. LPA Perry informed Sasha that any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. For water drinking, LPA Perry observed water containers (Igloos) with cups in the classrooms. LPA observed the food preparation area to be clean and free of litter, rubbish, rodents, and/or any other vermin and storage containers for solid waste, including movable bins with tight-fitting covers that are kept on, and in good repair. The facility was observed to be free of flies, other insects, and rodents. Lead testing was completed, and a visit was conducted to address the exceedance.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

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: 08/16/2024

NARRATIVE

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The following documents were posted in a prominent, publicly accessible area at the facility: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), Menu, and Earthquake Preparedness (LIC 9148). PUB 269 Child Passenger System Poster, and Daily Schedule. LPA Perry observed sign in/out sheets in the classrooms.

LPA Perry reviewed children’s files and observed the files to be complete.

LPA observed staff files and files were observed to be complete.

LPA reviewed Director Sasha Duarte CPR which expires on 8/2026 and Mandated Reporter training was observed and expires 8/9/26, Sasha was advised that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com.

Items discussed during this visit:

1. The following items are prohibited by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2. Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.

3. Current Children’s Roster: Each childcare facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.

4.LIC 311A - Records to be Maintained at the Facility: LPAs advised that forms, regulations, and quarterly updates can be accessed on the Child Care Licensing website at: www.ccld.ca.gov.

5.Pediatric First Aid and CPR: At least one person trained in Pediatric First Aid and CPR and EMSA approved must be present.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: 08/16/2024

NARRATIVE

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6.Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.

7.Qualifications: Educational background, training, and/or experience for each staff present must be available for review

8. Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles or influenza declination

9.Children’s Records: must be available for review; including but not limited to, the following: Name, address, and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

10.Staff Records: must be available for review; background clearance, LIC 503 Health Screening report, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Staff Qualifications, LIC 9050 Employee Rights, LIC 501 Personnel Record, AB 1207 Mandated Child Abuse Certification, MMR, TDAP, TB, influenza or influenza declination.

Criminal Record Clearance – Sasha was reminded that all adults 18 and over, 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care 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 21-21.1CCP).

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: 08/16/2024

NARRATIVE

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LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org – Sasha was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The facility is in compliance with California Code of Regulations Title 22 and no deficiencies will be cited today.

A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted and report was reviewed with Sasha Duarte, Director. Appeal rights provided and discussed.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC809 (FAS) - (06/04)

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