Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419929
Report Date: 01/12/2017
Date Signed 01/12/2017 04:38:45 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:20CENSUS: 20DATE:
01/12/2017
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:29 PM
MET WITH:Mali HeifetzTIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts(LPAs) Myriam Saullo Luga and Karen Starks met with the facility director and conducted a case management deficiency visit that was generated as during the investigation visit for complaint # 30-CC-20170104155726 and review of children records, it was noted that seven children's records were incomplete. This was addressed with the facility director who indicated that she will ensure that all children's records are complete. Type B deficiency was cited accordingly. There were 20 children and 4 teachers/teacher aides present during the visit. An Exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (310) 337-4332
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2


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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2017
Section Cited
101221(a)
1
2
3
4
5
6
7
101221(a) Child’s Records. The licensee shall ensure that there are separate, complete and current records kept for each child attending the child care center.
Seven children records were not complete
1
2
3
4
5
6
7
The faciltiy director will ensure that all children's records are complete and current. The facility director will send proof of correction to the department by 1/26/2017.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (310) 337-4332
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2