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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021184
Report Date: 09/19/2024
Date Signed: 09/19/2024 09:35:58 AM

Document Has Been Signed on 09/19/2024 09:35 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/
DIRECTOR:		SASHA DUARTEFACILITY TYPE:
850
ADDRESS:211 S. EVERGREEN AVENUETELEPHONE:
(323) 263-2816
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY: 46TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
09/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:20 AM
MET WITH:Sasha Duarte, DirectorTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On September 19, 2024, Licensing Program Analyst (LPA) Staicy Perry conducted an unannounced case management inspection to follow up with an incident that was reported to the department. LPA met with Sasha Duarte, Director, who guided LPA on a tour of the facility.

On 9/16/2024, it was reported to the department that during playground time C#1 bite C#2 on the arm. C#1 and C#2 were playing zombies in the playground and while the children were running, C#1 caught up to C#2 and C#1 bit C#2 on the arm S#1 and S#2 did observe the incident happen on the playground. The incident was reported to the Department within the 24-hour period and the written report was received during inspection on 9/19/2024.

During today’s inspection, LPA conducted interviews, declarations were obtained, and documentation was reviewed and obtained. C#1 bit C#2 9/16/24- incident was observed and ice was provided. The bite did not break the skin nor was there any mark, C#2 did not need to seek medical attention. Based on information obtained from S#1 and S#2 and review of documents, there were no corroborating information to determine that there was a lack of supervision during the incident. All reporting requirements were met.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Sasha Duarte.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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