197403133-10-12-2023-58-CC-SSAZ-CWJS3L-20231012133120

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197403133
Report Date: 10/12/2023
Date Signed: 10/12/2023 01:31:30 PM

Document Has Been Signed on 10/12/2023 01:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	BURBANK CENTER FOR THE RETARDED		FACILITY NUMBER:	197403133
ADMINISTRATOR:	MARIA DI LIBERTO		FACILITY TYPE:	840
ADDRESS:	230 E. AMHERST DRIVE		TELEPHONE:	(818) 843-4907
CITY:	BURBANK	STATE: CA	ZIP CODE:	91504
CAPACITY: 36	TOTAL ENROLLED CHILDREN: 4	CENSUS: 0	DATE:	10/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Edward Parker, Licensee		TIME COMPLETED:	01:50 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	Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced annual inspection today. LPA met with Edward Parker, Director who guided analyst on tour of facility. This is a school age program which consists of 2 classrooms (children's room & teen room). There is an adult day program on the same site (#197601136). The adult day program operates from 8:00 AM to 2:00 PM, and school age program operates from 2:00 PM to 6:00 PM. The facility is in compliance with the school-age sign/out procedures (101529.1) and is in compliance with staff-child ratios (101516.5). All areas identified on the Facility Sketch were inspected. During today's inspection there were no school age children present in the facility. The following was observed during tour of facility: Disaster drill log was available, last drill was conducted within six months (08/16/23). LPA observed required licensing documents posted on bulletin board. Smoke detector were observed to be in operable condition. LPA observed a fire extinguisher and was serviced on 08/09/2023. LPA observed both classroom to be clean and in good repair. Per Director Parker, currently due to low enrollment, only one classroom (children's room) is being used. The floors were clean and lighting was in operable condition. There were age appropriate toys and equipment. LPA observed water readily available via water pitchers provided by facility. LPA observed water bottles. LPA observed cubbies/storage area for children to store their personal belongings. First Aid kit was observed and inventoried. Per Director there are no poisons at the facility. Furniture and equipment were inspected for age appropriateness and good repair. LPA observed material and equipment are free of sharp, loose, or pointed parts. Telephone service, heating, lighting and ventilation were evaluated. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. Bathrooms were observed to be gender specific and they provide individual privacy for children. General sanitation was observed. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. According to the Director, no medication is administered.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BURBANK CENTER FOR THE RETARDED	FACILITY NUMBER: 197403133
	VISIT DATE: 10/12/2023

NARRATIVE

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At 10:50am, a staff member went to the store to purchased a carbon monoxide detector.

Menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides an afternoon snack. There is also a purified water source available for children to refill their water container. At 11:30am, LPA Sanchez asked if the facility had been tested for lead or if the facility submitted a wavier. Per Director, stated that the facility was not tested for lead. LPA gave director PIN 21-21. Type B was cited.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins have tight fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers at 45˚ (F) or less.

LPA observed that outdoor space is physically separate from all other components. LPA observed to pieces of wood sharp pointed parts. A technical violation was given. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The outdoor area had adequate shade. Per Director, children go the the park (McCambrigde Park) across the street with 2 adults. LPA did not observe any bodies of water during this visit. Director states there are no weapons or firearms on the premises.

Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and LIC 613A Personal Rights.

Staff records were reviewed for approved, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and current Mandated Reporter Training Certificate. All individuals present have obtained a criminal record clearance or criminal record exemption.

At 12:30 during staff file review, the facility did not have proof of any staff having CPR and Pediatric First Aid.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BURBANK CENTER FOR THE RETARDED	FACILITY NUMBER: 197403133
	VISIT DATE: 10/12/2023

NARRATIVE

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Consult was given regarding the following:

TSP
Facility name changed- LIC 200 was collected and dated 02/08/22.
Director name change
Fees- LPA provided PIN to pay fees online.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.html

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Based on the LPA’s observations, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22 Chapter 1 and Section CCR & H&S. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were given. Exit interview conducted and report was reviewed with the Director Parker.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/12/2023 01:31 PM - It Cannot Be Edited

Created By: Susann Sanchez On 10/12/2023 at 01:07 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above. Director stated they completed the required lead testing. This poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/13/2023
	Plan of Correction
1 2 3 4	Per Director will read PIN 21-21 and submit a wavier to the department.

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. Director was not able to provide a EMSA approved pediatric CPR/1st aid certificare for a staff member in the Preschool program, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/13/2023
	Plan of Correction
1 2 3 4	Per Director will provide current certificates and email LPA proof by 11/13/23

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Susann Sanchez

LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC809 (FAS) - (06/04)

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