<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403133
Report Date: 12/04/2019
Date Signed: 12/04/2019 05:19:37 PM

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 CENTER FOR THE RETARDEDFACILITY NUMBER:
197403133
ADMINISTRATOR:MARIA DI LIBERTOFACILITY TYPE:
840
ADDRESS:230 E. AMHERST DRIVETELEPHONE:
(818) 843-4907
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY:36CENSUS: 9DATE:
12/04/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:46 PM
MET WITH:Edward Parker, Director AssistantTIME COMPLETED:
05:15 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 12/4/2019 at 3:46pm Licensing Program Analyst's (LPA's) Denise Miranda conducted an unannounced case management inspection for the purpose of deficiencies observed during a plan of correction inspection conducted on 12/4/2019.
Upon arrival LPA observed one classroom with a ratio of 3 teachers to 9 children. Facility is licensed for after school program.

LPA Miranda observed the facility failed to notify the department of a change in facility director within the 10-day allotment and the director does not meet the qualification requirements to be an infant director, this will result in two Type B deficiency.

Type B deficiency was cited during today's inspection (see LIC 809D).

An exit interview was conducted with Director Assistant Edward Parker. A copy of this report, notice of site visit, and appeal rights were provided to the director assistant.

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BURBANK CENTER FOR THE RETARDED
FACILITY NUMBER: 197403133
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2019
Section Cited

1
2
3
4
5
6
7
101515 (b) All school-age child care centers shall have a director. This requirement is not met as evidenced by: LPA Miranda observed the facility failed to notify the department of a change in facility director within the 10-day allotment. This is a Type B citation and poses a potential health and safety risk.

1
2
3
4
5
6
7

1
2
3
4
5
6
7

1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2