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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494819
Report Date: 05/07/2021
Date Signed: 05/07/2021 10:42:52 AM

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:LEVITT FAMILY CHILD CAREFACILITY NUMBER:
197494819
ADMINISTRATOR:LEVITT, VIRGINIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 536-4462
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:14CENSUS: 0DATE:
05/07/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Applicant - Virginia LevittTIME COMPLETED:
01:15 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 05/06/2021 at 1:00pm, Licensing Program Analyst (LPA) Ericka Hill contacted the Applicant to conduct a Pre-Licensing visit for a Small Child Care License. During the application process the applicant requested to switch their application from a Large to a Small Family Child Care. This visit was conducted by tele-visit communications due to COVID-19 restrictions.

Indoor areas:
Accessible: The backyard child care room and Bathroom #2 (located in the front main house). During the visit, LPA observed the backyard child care room and Bathroom #1 to be equipped with age-appropriate toys, materials, and equipment for daycare children. LPA did not observe any hazardous materials accessible to the children within these child care areas. LPA observed the accessible areas to be clean, free of hazardous items, and providing age-appropriate materials.

Inaccessible: Most areas in the front main home are inaccessible such as the Kitchen, Bedroom #1, Bedroom #2, Bedroom #3, Bathroom #1, Den, Living room, Dining room, and Laundry area. LPA observed these areas to be clean, free of hazardous items, and inaccessible to the children in care.

Record Keeping:
LPA observed the required documents on the Parent Board and discussed the documents needed for children and employee records.

Outdoor Area:
LPA Hill observed age-appropriate toys, materials, and equipment for the children in care. The outdoor area was observed to be fully fenced, clean, free of hazardous materials, provided plenty of shade, and the bottom of the play equipment was cushioned with grass to decrease injuries.
{report continues on pg. 2}
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Ericka HillTELEPHONE: (424) 301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
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: LEVITT FAMILY CHILD CARE
FACILITY NUMBER: 197494819
VISIT DATE: 05/07/2021
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
26
27
28
29
30
31
32
LPA informed the applicant to have COVID-19 equipment and materials on-site such as a thermometer, gloves, cleaning, and disinfecting products, hand sanitizer, and COVID-19 signs in the facility

An exit interview was conducted with the Applicant. A copy of this form, (LIC809), was provided to the Applicant. LPA Hill requested the Applicant to read, sign, and email the the LIC809 back to LPA Hill.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Ericka HillTELEPHONE: (424) 301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2