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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403133
Report Date: 12/04/2019
Date Signed: 12/04/2019 05:18:32 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: 0DATE:
12/04/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Edward Parker, Director AssistantTIME COMPLETED:
03:45 PM
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On 12/4/2019 2:10pm Licensing Program Analyst (LPA) Denise Miranda arrived at the facility to conduct a Plan of Correction visit to observe facility operations. Facility was cited for the deficiency below during the Complaint visit conducted on 11/06/2019.

1) 101238.2 (d) (1) and (2) Outdoor Activity Space: The surface of the outdoor activity space shall be maintained: In a safe condition for the activities planned and free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

During this plan of correction inspection facility was not able to correct the deficiency due the holidays. Director assistant requested to extend the plan of correction for next 01/23/2020. LPA agreed to extend the plan of correction for no later than 1/23/2020. Per Director Assistant, facility will be closed from 12/23/2019 to 01/03/2020. The outdoor playground will be off limit and the children in care will not have access to the outdoor space until the plan of correction will be correct and get clear of the plan of correction from Licensing. Director assistant provided copies of the emails regarding quotes requesting and quote received from companies that install playground surfacing.
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)
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