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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021184
Report Date: 07/28/2026
Date Signed: 07/28/2026 02:40:39 PM

Document Has Been Signed on 07/28/2026 02:40 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 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: 5CENSUS: 2DATE:
07/28/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Director, Raquel JamersonTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On July 28, 2026, an unannounced case management inspection was conducted by Licensing Program Analyst Staicy Perry, in response to a change in facility Director. LPA Perry met with newly appointed director, Raquel Jamerson. 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 Raquel Jamerson, the children are her 9:00am-3:30pm. Per Raquel Jamerson there are 5 children currently enrolled. Census was taken and LPA Perry observed 2 children and 3 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.

Director Raquel Jamerson, started on July 27, 2026, and LPA Perry was notified of the change on June 27, 2026 by newly appointed Director Raquel Jamerson as well as Deisy Rodriguez, Administrative Clerk, City of Los Angeles Department of Recreation and Parks Child Care Program on Tuesday, July 28, 2026. LPA Perry received and reviewed all required documentation related to the facility’s transition of director’s responsibilities to Raquel Jamerson. LPA conducted a checklist review with the new director and completed and discussed a LIC 308 – Designation of Responsibility form.LPA Perry reviewed the following and LPA Perry verified receipt, obtained copies of the following documents for Raquel Jamerson, Director:

· LIC 308 – Designation of Administrative Responsibility

· LIC 500 – Personnel Report

· LIC 501 – Personnel Record

· LIC 508 – Criminal Record Statement

Brandi VanOosten
Staicy Perry
DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 07/28/2026
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·LIC 9052 – Employee Rights

· LIC 9108 – Statement Acknowledging Requirement to Report Child Abuse

· Proof of immunization's (MMR, TDAP, Influenza or annual declination)

· Mandated Reporter Training Certificate (completed within the last 2 years)

· Pediatric CPR/First Aid certification (current, EMSA Approved)

· Director/Site Supervisor qualifying transcripts

· CCLD Orientation

· Preventative Health and Safety Certification

· References

LPA Perry verified that all required forms and supporting documents were submitted and in compliance with Title 22 requirements. LPA has confirmed all documents have been submitted. The new director Raquel Jamerson was informed that the administrative records will reflect the change in director to Raquel Jamerson once all submitted documents are officially processed in the system.

At this time no deficiencies were cited. A Notice of Site Visit was issued and will remain posted at the facility for public viewing. LPA discussed and provided appeal rights with the facility and exit interview conducted with Director Raquel Jamerson.

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC809 (FAS) - (06/04)
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