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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494850
Report Date: 12/04/2024
Date Signed: 12/04/2024 02:56:02 PM

Document Has Been Signed on 12/04/2024 02:56 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 YMCA HORACE MANN CHILDRENS CENTERFACILITY NUMBER:
197494850
ADMINISTRATOR/
DIRECTOR:		DIERIK GONZALEZFACILITY TYPE:
830
ADDRESS:3401 SCOTT ROADTELEPHONE:
(818) 729-1650
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 9DATE:
12/04/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Staff / Tsha Johnson
Director / Dierik Gonzalez		TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 12/4/24, at 1:45PM, Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced Plan of Correction (POC) Visit. Upon arrival, LPA met with Staff / Tsha Johnson who guided LPA on a tour of the facility. The Director / Dierik Gonzalez joined the visit sometime after. Licensee serves 16 infants, ages 0 to 24 months (no more than 14 infants up to 12 months) and 24 toddlers ages 18 to 36 months. The infant program consists of 1 classroom. The following staff/children were present during this inspection: Infant Room/Classroom 14: 2 staff & 5 children. The toddler program consists of 2 classrooms (Classrooms 1 & 2). The following staff/children were present during this inspection: Classroom 1: 1 staff & 4 children. Classroom 2 is currently not being used. LPA disclosed the purpose of the inspection.

During the POC inspection conducted on 11/21/24, the following deficiency was re-issued/cited as Licensee failed to meet the POC which was initially due on 11/14/24 (Civil Penalty was issued).;
  • Physical Plant - Type B: 101238(a) - Infestation of ants were observed in the infant classroom top/upper cabinet, where snacks are stored for children in care, during the Annual/Random inspection conducted on 10/31/24. POC was submitted to LPA at the time of visit on 11/21/24.


This deficiency has been cleared and the facility is in compliance with this regulation.

A notice of site visit was given and must remain posted for 30 days.
Exit interview was conducted, report was reviewed with the Director and copies provided, along with Appeals Rights.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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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