Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419929
Report Date: 05/12/2017
Date Signed 05/12/2017 03:59:43 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:HAIFETZ, MALIFACILITY TYPE:
850
ADDRESS:13624 BURBANK BLVDTELEPHONE:
(818) 786-7800
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91401
CAPACITY:20CENSUS: 20DATE:
05/12/2017
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Sapir AdaniTIME COMPLETED:
03:50 PM
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Licensing Program Analyst(LPA) Myriam Saullo Luga conducted a case management visit for the purpose of capacity increase of the facility. LPA met with licensee and explained the purpose of the visit. The facility requested a capacity increase to 45 children from current license capacity of 20 children. Fire clearance and certificate of occupancy were obtained.

LPA with licensee toured the facility indoor and outdoor. The facility looked clean and orderly. Napping equipment were in good repair. Children’s belongings were stored separately. Isolation area met regulation requirement. Food preparation area was clean. The kitchen was clean. Outdoor area/playground was cushioned and equipped with age appropriate structure/equipment and was free of hazardous material/debris.

LPA reviewed facility's sketch which matched the physical plant of the facility. There were teachers and children during the visit. Teachers to child ratio of 1 teacher to 4 infants was observed. LPA reviewed the facility's current/updated “Designation of Facility Responsibility” (LIC 308), current/updated “ Administrative Organization (LIC309) and a current/updated Personnel record (LIC 500).
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (310) 337-4332
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2017
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: 05/12/2017
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LPA reviewed sample staff's and children's records and they were complete.

LPA measured the facility:

Facility's indoor measurement :

Classroom 1 : 154 sf
Classroom 2: 265.2
Classroom 3: 307.05
Classroom 4: 320.07
Classroom 5: 228.72

Total SF: 1275.04 sf/35 sf = 36 children

Outdoor area measurement:
Front Yard: 1925 sf
Back Yard: 936 sf

Total: 2861sf/ 75 sf = 38 children

Bathroom:

One bathroom with 3 toilets and 3 sinks.
A separate bathroom for teacher that was clean and orderly.

Bathroom were equipped with hot/cold water, paper towels, toilet paper and soap. Bathrooms were clean and orderly.

Total/maximum capacity of the facility based on the most restrictive number = 36 children

The facility is ready to obtain a license capacity increase to 36 children .
An Exit interview was conducted and a copy of this report was submitted to facility director.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (310) 337-4332
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2017
LIC809 (FAS) - (06/04)
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