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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200980
Report Date: 03/10/2022
Date Signed: 03/10/2022 03:43:57 PM


Document Has Been Signed on 03/10/2022 03:43 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:BURBANK 1ST UNITED METHODIST CHURCH NURSERY SCHOOLFACILITY NUMBER:
191200980
ADMINISTRATOR:VIVIEN FIRTAFACILITY TYPE:
850
ADDRESS:700 NORTH GLENOAKSTELEPHONE:
(818) 848-3233
CITY:BURBANKSTATE: CAZIP CODE:
91502
CAPACITY:75CENSUS: 6DATE:
03/10/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Acting Director, Kristina Balos TIME COMPLETED:
04:00 PM
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On 3/10/2022 Licensing Program (LPA) Dalicia Adkins conducted an unannounced case case management- follow up visit. LPA met with Director Kristina Balos, LPA informed director about the purpose of the visit and LPA was granted entry in the facility. Director provided LPA of a tour of the facility. LPA observed 6 children and 8 teachers. This is a half day program and most of the children had been picked up.

LPA observed Covid signage posted near the front door entry. Daily symptom screening conducted during drop off and non touch thermometer used to check temperatures. LPA observed PPE and sand sanitizer through the facility. Parents utilizes pro care communication platform for check their child in/out and check in times are staggered. LPA observed children and staff wearing masks.

LPA Adkins discussed the following with Director: social distancing, hand washing, sanitizing, and placement of classroom furniture. Children have their meals outside and remain with their assigned group. Isolation area located outside, child will be supervised in isolation area until he/she is picked up.
LPA Adkins observed bathrooms to be stocked with hand washing soap, paper towel, toilet paper and non-touch trashcans.
Director reported children were cleared to return back to school, has resumed back to normal activities and are doing well.
LPA Adkins discussed new mask mandate updates and provided technical assistance. LPA completed Covid 19 Self Assessment with director.

This report reviewed with director and a copy of this report provided.
No deficiencies cited during today's visit 3/10/2022.
Exit interview conducted.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Dalicia AdkinsTELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022
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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