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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197403133
Report Date: 11/06/2019
Date Signed: 11/06/2019 04:11:19 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2019 and conducted by Evaluator Denise Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20191028113343
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: DATE:
11/06/2019
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Edward Parker, Director AssistantTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Outdoor activity space is not maintained in a safe condition
INVESTIGATION FINDINGS:
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On 11/6/2019 at 12:15pm, Licensing Program Analyst (LPA) Denise Miranda arrived at Burbank Center for the Retarded, 230 E. Amherst Drive, Burbank, CA 91504 for the purpose of investigating the above-mentioned allegation. LPA met with Edward Parker, Assistant Center Director, and discussed the purpose of the visit. LPA observed no children in care. Around 3:3:45pm LPA observed 9 children in care with 3 staffs providing care and supervision.
Based on observation and inspections conducted, it was revealed that on 11/6/2019 at 12:25pm
Mr. Parker guided LPA Miranda tour of facility inside and outside. At the outdoor area, LPA observed wood pallets and the cushing floor area with holes, gaps and nails out of the floor by the main entrance door to access the outdoor area.
A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The facility is issued a Type B citation today, 11/06/2019. (See LIC 9099-D for deficiency cited). An exit interview was conducted and a copy of this report, appeal rights and Notice of Site Visit were provided to Edward Parker, Center Director.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 30-CC-20191028113343
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 11/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2019
Section Cited
CCR
101238(d)(1)(2)
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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. This requirement is not met as evidenced by:
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During this inspection, LPA observed the wood pallets were removed from outdoor area to an off limit area.
Director assistant provided a declaration stated that outdoor area will be as an off limit and children in care will not have access until complete the plan of correction

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 on 11/6/2019,LPA observed woods pallets and the cushing floor area with holes, gaps and nails out of the floor by the main entrance door to access the outdoor area. This is a Type B citation and poses a potential health and safety risk to children.

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and the Department approve prior the installation of Cushing. Per Director assistant the plan of correction will be correct no later than 12/2/2019.
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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.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
LIC9099 (FAS) - (06/04)
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