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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197494333
Report Date:
09/01/2021
Date Signed:
09/01/2021 11:14:24 AM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
09/01/2021 11:14 AM
- It Cannot Be Edited
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:
DISNEY CHILDREN'S INFANT CENTER
FACILITY NUMBER:
197494333
ADMINISTRATOR:
CORTRITE, JENNIFER
FACILITY TYPE:
830
ADDRESS:
235 S EDISON ROAD
TELEPHONE:
(818) 560-5437
CITY:
BURBANK
STATE:
CA
ZIP CODE:
91506
CAPACITY:
24
TOTAL ENROLLED CHILDREN:
0
CENSUS:
DATE:
09/01/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:46 AM
MET WITH:
TIME COMPLETED:
11:13 AM
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SUPERVISORS NAME
:
Peter Flores
LICENSING EVALUATOR NAME
:
Laticia S Thompson
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/01/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/01/2021
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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