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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494851
Report Date: 05/22/2024
Date Signed: 05/22/2024 02:40:34 PM

Document Has Been Signed on 05/22/2024 02:40 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 CHILDRENS CENTER PRESCHOOLFACILITY NUMBER:
197494851
ADMINISTRATOR/
DIRECTOR:		DIERIK GONZALEZFACILITY TYPE:
850
ADDRESS:3401 SCOTT RDTELEPHONE:
(818) 729-1650
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY: 146TOTAL ENROLLED CHILDREN: 146CENSUS: 34DATE:
05/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Director / Dierik GonzalezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 5/22/24, at 1:30PM, Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced Case Management Visit to this facility. Upon arrival, LPA met with Director / Dierik Gonzalez,
who guided LPA on a tour of the facility. There were 34 children with 5 staff observed present in the preschool program. LPA explained the purpose of today's visit is to follow-up on an incident that was reported to Community Care Licensing (CCL) on 5/14/24.

The incident that occurred on 5/14/24, was reported to the Department on 5/14/24, via telephone.
The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that Child #1's personal rights may or may not have been violated.

During today's visit, LPA conducted interviews regarding this incident. LPA also obtained rosters and other pertinent information regarding this incident. Pictures were taken of the physical plant.

Based upon information received from the interviews conducted it was determined that the personal rights of Child #1 were not violated.

There were no deficiencies cited during today’s inspection.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

An exit interview was conducted with Director / Dierik Gonzalez and Appeals Rights provided.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2024
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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