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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019459
Report Date: 08/01/2019
Date Signed: 08/01/2019 10:45:39 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:BURBANK COMMUNITY YMCAFACILITY NUMBER:
198019459
ADMINISTRATOR:ANGELA BUCKFACILITY TYPE:
830
ADDRESS:332 SAN JOSE AVETELEPHONE:
(818) 562-5461
CITY:BURBANKSTATE: CAZIP CODE:
91502
CAPACITY:10CENSUS: 4DATE:
08/01/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Angela Buck, Sr, DirecterTIME COMPLETED:
11:00 AM
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LPA Sophia Lord-Richard attempted to conducted an inspection for of a capacity Increase in an Infants Center. According to the Director the increase in capacity was for 12 more infants not 2 more. The Center withdraw the capacity increase application. They will submit a new increase capacity for a total increase of 24 Infants. The Center submitted a withdrawal letter.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sophia Lord-RichardTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
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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