Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419929
Report Date: 08/12/2015 12:00:00 AM
Date Signed 08/17/2015 08:17:59 AM

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:ADANI/RAZLA, SAPIRFACILITY TYPE:
850
ADDRESS:13624 BURBANK BLVDTELEPHONE:
(818) 786-7800
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91401
CAPACITY:45CENSUS: 0DATE:
08/12/2015
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Sapir Adani-RazlaTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Silva Garibyan conducted an announced pre-licensing visit to the facility. LPA met with the applicant, Sapir Adanirazla.

LPA was guided on a tour of the facility, both indoors and outdoors. Fire Clearance/STD 850 form has been provided to LPA ( approved for total capacity of 45). The facility will operate out of 5 classrooms. The indoor measurements were as such:

Room 1: (23 x 14) + ( 4 x 5) = 342 sq. ft.
Room 2: (11.3 x 14) + ( 8.11 x 8 ) = 223.08 sq. ft.
Room 3: 12.8 x 14 = 179.2 sq. ft.
Room 4: ( 14 x 20 ) + ( 6 x 8.7 ) = 332.2 sq. ft.
Room 5: 12.8 x 12 = 153.6 sq. ft.

Total capacity for the preschool is 342 + 223.08 + 179.2 +332.2 + 153.6= 1,230.08 /35 = 35 children

The preschool bathrooms have 4 toilets and 4 sinks.

There is a separate staff bathroom ( in room # 4 ) which will also be used by sick children. The isolation area is in the director's office.
The outdoor space ( back and front yards) is completely fenced in and there are no bodies of water. There is adequate shade for the children when occupying the outdoor space.
Outdoor space for preschool children: ( 32 x 38.6 ) + ( 20 x 18 ) + ( 11 x 19 ) + ( 33 x 49 ) = 3,421.2 sq. ft./ 75 = 45 children
Based upon the indoor measurements, the facility will accommodate a total of 35 children.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2015
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: 08/12/2015
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 The following forms are required to designate a new facility director:
  • LIC308 - Designation of Facility Responsibility
  • LIC508 - Criminal Record Statement
  • LIC9108 - Requirement to Report Suspected Child Abuse
  • LIC500 - Personnel Report
  • LIC501 - Personnel Record for Director
  • LIC503 - Health Screening Form for Director and TB clearance
  • LIC610 - Emergency Disaster Plan
  • Coursework verification and summary of experience to meet qualification requirements
  • Copies of Certificates for Pediatric CPR, Pediatric First Aid and Preventative Health and Safety
  • Board Resolution authorizing the designation of the new Preschool Director

The above forms are due to Community Care Licensing by 08/21/15.

Additional forms and a copy of Title 22 Regulations may be obtained at the department's website www.ccld.ca.gov

Exit interview was conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2015
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: 08/12/2015
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The center has appropriate furniture, play and napping equipment indoors and outdoors. There is water accessible to children at all times indoors & outdoors.

Outdoor equipment was inspected for health, safety, cushioning material, good repair and age appropriateness. Play area does not have any hazards or bodies of water.



Furniture/Equipment/Toys/Books
There are plenty of toys, books and material for children in care to utilize.

Napping Area/Equipment
The program will be open from 8:00am to 5:00pm from Monday to Thursday, and from 8:00 am to 3:00 pm on Friday. The center has appropriate napping equipment.
Parents and children will access the facility from the main entrance..

Lunches
Lunches will be prepared by the school. The facility will provide 2 snacks daily. Food preparation area was inspected . Lunch/Snack Menu are to be posted for parents to view. Food preparation area is adequately equipped, clean and free from hazards. Cleaning supplies shall be kept out of reach of children and stored separately and away from food. There is hot and cold running water in the food preparation area. The Refrigerator is/will be clean and operating at the proper temperatures. Trash cans have lids on.

Medication
During this visit, Incidental Medical Services were discussed. Medication if administered is to be properly labeled and stored in the original container. Director advised that children should be screened every morning for illness and unusual marks. First Aid supplies are stored in the classrooms.

Sign In/Out
Director is to ensure that parents sign in and out daily using their full and legal signature.



SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2015
LIC809 (FAS) - (06/04)
Page: 3 of 3