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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494554
Report Date: 10/14/2021
Date Signed: 10/14/2021 02:00:02 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 MONTESSORI ACADEMYFACILITY NUMBER:
197494554
ADMINISTRATOR:KITHMINI CURRYFACILITY TYPE:
850
ADDRESS:217 N HOLLYWOOD WAYTELEPHONE:
(818) 848-8226
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:45CENSUS: 52DATE:
10/14/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:41 AM
MET WITH:Kithmini Curry, Licensee/DirectorTIME COMPLETED:
02:15 PM
NARRATIVE
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On 10/14/2021 at 9:00AM, Licensing Program Analyst (LPA) Denise Miranda and Licensing Program Manager (LPM) Claudia Escobedo arrived at Burbank Montessori Academy located at 217 Hollywood Way, Burbank, CA 91505, for the purpose of a Case Management- licensee initiated visit. LPA and LPM met with Director, Kithmini Curry, who guided analyst on a tour of the facility.
Per Director, there are 52 children present being supervised by 11 staff members. LPA and LPM obtained a copy of sign in and sign out and children’s roster. Current facility capacity is for 45 children.
On 07/15/2021, the facility was cited in violation of Title 22 CCR Title 22, Division 12 Chapter 1 Article 02
Licensing 101161(a) – Limitations on Capacity. On 07/16/2021 facility was cited a repeat violation of Title 22 CCR Title 22, Division 12 Chapter 1 Article 02 Licensing 101161(a) – Limitations on Capacity.
Today 10/14/2021, Licensee was cited one Type A deficiency, according to California Code of Regulations Title 22 (see LIC 809D report for deficiencies).
The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. LPA provided a copy of this form to the licensee. The report shall be provided no later than the next business day or the next day the child is in care. LPA provided a copy of the form LIC9224.
This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

In addition; A copy of this report must be provided to a parent or an authorized representative of all currently enrolled children and any newly enrolled child for the following 12 months.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
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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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 MONTESSORI ACADEMY
FACILITY NUMBER: 197494554
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/15/2021
Section Cited

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A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement is not met as
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evidenced by:
Based on Director information and LPA and LPM observation on sign and out, there were 52 children in care from the age group 2 to 6 years.
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10/15/2021, via email to LPA
Miranda.The LIC 9224 form shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day.

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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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2021
LIC809 (FAS) - (06/04)
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