Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419929
Report Date: 10/22/2015
Date Signed 10/22/2015 03:47:04 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: 35DATE:
10/22/2015
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:ADANI/RAZLA, SAPIRTIME COMPLETED:
04:00 PM
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Licensing Program Analysts (LPAs) Silva Garibyan and Myriam Luga conducted a Case Management visit at the request of the facility to measure the new addition to classroom # 3. The facility has undergone new construction and added 118 sq. ft to the classroom #3. The existing 4 classrooms ( #1, 2, 4 and 5) remain the same.
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The facility has recently hired a new Director. Staff present has current CPR and First Aid. LPAs reviewed staff and children's files. Director must attend Operations and Record Keeping orientation.

The LPAs discussed the licensee's ownership as an individual versus a Corporation.

LPAs explained to the licensee that the applicant name change is also considered a change in ownership, therefore a new application will result in the issuance of a new license number.




No deficiencies observed at the time of the visit.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2015
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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