Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419929
Report Date: 11/20/2015
Date Signed: 11/20/2015 04:11:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:MUSICAL GANFACILITY NUMBER:
197419929
ADMINISTRATOR:HAGBI,RUCHAMAFACILITY TYPE:
850
ADDRESS:13624 BURBANK BLVDTELEPHONE:
(818) 786-7800
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91401
CAPACITY:35CENSUS: 29DATE:
11/20/2015
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:33 PM
MET WITH:Sapir AdaniTIME COMPLETED:
04:30 PM
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Licensing Program Analysts(LPA) Myriam Saullo Luga and Silva Garibyan met with the facility licensee to conduct a case management visit in light of the new fire clearance that the department recently received. On 11/10/2015, the department received a fire clearance for a maximum capacity of 20 children based on the zoning of the facility. There were 29 children and 5 staff present present during the visit.
The indoor space was composed of 4 classrooms and the outdoor is conducted in the play yard in the back of the facility. The facility originally was licensed for outdoor area in the front yard. However, the licensee recently notified the department that the front yard was converted to a parking area and is no longer used for outdoor space.
LPAs measured the current facility indoor and outdoor.
Indoor space measurements:
Classroom 1 : 21 x 13.5= 283.5 sf

Classroom 2: (6.2x11) + (7.8x20)= 224.2

Classroom 3: 14.4x27= 388.8

Classroom 4: (13.8 x 19.7) + (5x6) = 301

Total indoor space: 1197.5/35 square feet per child= 34 children
Indoor space can accommodate 34 children

Outdoor Space:
(31x36.7)+ (20 x 17.6)+ (7.4 x 15)= 1600.7sf/75= 21 children.
Total outdoor space can accommodate up to 21 children.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2015
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
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: MUSICAL GAN
FACILITY NUMBER: 197419929
VISIT DATE: 11/20/2015
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The maximum number of children the facility can accommodate is 34 children indoor and outdoor.
However, in light of the new fire clearance for a maximum of 20 children , the facility license would need to be reduced to 20 children. Licensee notified LPAs that the facility licensee changed to corporation. The licensee indicated that she would update the application to reduce the children center facility license and reflect the new name of licensee. Along with the application, the facility owner will submit the following documents reflecting the new name of the licensee/facility:
Designation of Facility Responsibility (LIC 308).
Administrative Organization (LIC309)
Financial Information Release and Verification (LIC404)
Personnel Report (LIC 500) showing current roster.
Licensee affidavit regarding persons exempt from fingerprint requirements (Use back of LIC 500).
Emergency Disaster Plan (LIC 610) (a posting requirement; see below) with verification that disaster drills are conducted every six months.

The facility owner submitted and updated application, LIC 308, LIC 309 and the Secretary of State Seal to the department during this visit. Licensee will send the other documents by 12/1/2015.

An Exit interview was conducted and a copy of this report was submitted to the facility.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2015
LIC809 (FAS) - (06/04)
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