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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304371532
Report Date: 10/13/2023
Date Signed: 10/13/2023 11:03:36 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2023 and conducted by Evaluator Cindy Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230911091731
FACILITY NAME:EVERBROOK ACADEMYFACILITY NUMBER:
304371532
ADMINISTRATOR:BROWN, BARBARAFACILITY TYPE:
850
ADDRESS:16498 ROYAL OAKTELEPHONE:
(949) 559-6810
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY:195CENSUS: 34DATE:
10/13/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director, Barbara BrownTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff do not properly supervise day care children.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced complaint investigation. This is a continuation of the investigation initiated on 09/15/2023. LPA met with Barbara Brown, Director who accompanied LPA on a tour of the facility. Census was taken as follow: 34 preschool children with 5 staff members. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staff to child ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 09/11/2023 a complaint was filed with the Department alleging (1) staff do not properly supervise day care children and (2) unqualified staff is supervising day care children. During the investigation, LPA Nguyen conducted 2 physical plant inspections, interviewed the complainant, interviewed 4 staff members, reviewed 4 personnel records, and obtained a copy of the children's roster.
Continued on 9099C Page 1

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 06-CC-20230911091731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: EVERBROOK ACADEMY
FACILITY NUMBER: 304371532
VISIT DATE: 10/13/2023
NARRATIVE
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Page 9099C Page 1

Complainant alleged on 09/05/23 around 9:00am -10:00am, four children in the two’s class got out of the daycare. The complainant stated the children were all outside on the toddler playground when the four children went through a heavy gate with a center push bar, and no one noticed or knew they were gone. Complainant stated that 10 minutes later a parent arrived to drop off their child and found the children outside on the opposite side of the building by the dumpsters. When parents alerted staff none of them even knew they were missing.

This incident was self-reported to Community Care Licensing (CCL) office on 09/06/2023. The facility reported on 09/05/2023, at 9:18am, the two-year-old class students were playing outside in the Toddler Playground with their teacher (S2). At approximately 9:22am, the three children had averted the S2s gaze and exited the playground through the side gate. Approximately 2 minutes later, while conducting an attendance check, S2 noticed the gate was left ajar. S2 ran to check if students had passed the gate and found Child #1 (C1), Child#2 (C2), and Child #3 (C3) outside of the school premises.

Staff #2 (S2) interviewed stated S2 was conducting an attendance check for the two-year-old class students in the toddler playground when S2 noticed the gate left ajar. S2 advised Staff #3 (S3) checked the count of the classroom while S2 ran to check for any students that had past the gate, which is the front of the school and enters the parking lot. S2 found three children outside of the school premises near the dumpsters of the school. LPA measures approximately 115 ft from the gate to where the children were found.

Based on LPA’s observations, interviews conducted with the complainant, interviewed 4 staff members, a self-reported incident and records reviewed, it has been determined that staff do not properly supervise day care children. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, 101229(a)(1) Responsibility for Providing Care and Supervision is being cited on the attached LIC 9099D.

A civil penalty of $500 was assessed today.

Continued on Page 9099 C Page 2

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 06-CC-20230911091731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: EVERBROOK ACADEMY
FACILITY NUMBER: 304371532
VISIT DATE: 10/13/2023
NARRATIVE
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Page 9099 C Page 2

LPA informed Director, Barbara Brown that this report dated 10/13/2023 document a Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

LPA also informed the Director, Barbara Brown to provide a copy of this licensing report dated 10/13/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted with Director, Barbara Brown. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2023 and conducted by Evaluator Cindy Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230911091731

FACILITY NAME:EVERBROOK ACADEMYFACILITY NUMBER:
304371532
ADMINISTRATOR:BROWN, BARBARAFACILITY TYPE:
850
ADDRESS:16498 ROYAL OAKTELEPHONE:
(949) 559-6810
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY:195CENSUS: 34DATE:
10/13/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director, Barbara BrownTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
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8
9
Unqualified staff is supervising day care children.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced complaint investigation. This is a continuation of the investigation initiated on 09/15/2023. LPA met with Barbara Brown, Director who accompanied LPA on a tour of the facility. Census was taken as follow: 34 preschool children with 5 staff members. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staff to child ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 09/11/2023 a complaint was filed with the Department alleging that staff do not properly supervise day care children and unqualified staff is supervising day care children. During the investigation, LPA Nguyen conducted 2 physical plant inspections, interviewed the complainant, interviewed 4 staff members, reviewed 4 personnel records, and obtained a copy of the children's roster.
Continued on 9099A C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 06-CC-20230911091731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: EVERBROOK ACADEMY
FACILITY NUMBER: 304371532
VISIT DATE: 10/13/2023
NARRATIVE
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Page 9099A C

Complainant alleged Staff #3 (S3) is not qualified to work in the two-year-old classroom. The complainant stated that they don’t know the staff name, however, the possible first initial of the staff was provided.

During the staff interviews, all 4 interviewed staff denied any unqualified staff in the two-year-old classroom.

LPA reviewed 4 personnel records, all staff providing care and supervision in the two-year-old classroom are qualified to be with the children.

Based on the information gathered from LPA interview with 4 staff members, and reviewed 4 personnel records, there is insufficient evidence to corroborate the allegation that a teacher not qualified working in the two-year-old class. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Director, Barbara Brown. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 06-CC-20230911091731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: EVERBROOK ACADEMY
FACILITY NUMBER: 304371532
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/13/2023
Section Cited
CCR
101229(a)(1)
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101229 Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child shall be left without the supervision of a teacher at any time, Supervision shall include visual observation. This requirement is not met as evidenced by:
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Director provided staff meeting with supervision training and a list of the signatures of the staff that attended the meeting and proof was sent to LPA on 10/05/23.
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Based on LPA interviews and record review, S3 failed to provide supervision for the three children. The three children were able to exit the facility to the parking lot. This poses an immediate Health and Safety risk to the children in care.
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A civil penalty of $500 was assessed today.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6