<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494850
Report Date: 11/21/2024
Date Signed: 11/21/2024 03:41:55 PM

Document Has Been Signed on 11/21/2024 03:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BURBANK YMCA HORACE MANN CHILDRENS CENTERFACILITY NUMBER:
197494850
ADMINISTRATOR/
DIRECTOR:		DIERIK GONZALEZFACILITY TYPE:
830
ADDRESS:3401 SCOTT ROADTELEPHONE:
(818) 729-1650
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: DATE:
11/21/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Staff / Alexis Castaneira
Director / Dierik Gonzalez		TIME VISIT/
INSPECTION COMPLETED:
04:00 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
On 11/21/24, at 2:30PM, Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced Plan of Correction (POC) Visit. Upon arrival, LPA met with Staff / Alexis Castaneira and was later joined by the Director / Dierik Gonzalez who guided the LPA on a tour of the facility. Licensee serves 16 infants, ages 0 to 24 months (no more than 14 infants up to 12 months) and 24 toddlers ages 18 to 36 months. The infant program consists of 1 classroom. The following staff/children were present during this inspection: Infant Room/Classroom 14: 2 staff & 4 children. The toddler program consists of 2 classrooms (Classrooms 1 & 2). The following staff/children were present during this inspection: Classroom 1: 2 staff & 6 children. Classroom 2 is currently not being used. LPA disclosed the purpose of the inspection.

During the Annual/Random inspection conducted on 10/31/24, the following deficiencies were issued;
  • Physical Plant - Type B: 101238(a) - Infestation of ants were observed in the infant classroom top/upper cabinet, where snacks are stored for children in care. Licensee did not submit a written Plan of Correction (POC) to ensure compliance with Title 22 Regulations Section 101238(a).
  • Physical Plant - Type B: 101238.2(d)(2) - Part of the toddler classroom wall located outside, in the toddler play area was in disrepair. There was a large hole in the wall with mesh wires and pipes visible on the inside. The hole was being covered by a cardboard box with sand equipment/toys in front. POC was submitted to CCL by the POC due date.
  • Staff Records - Type B: 101216(g)(1) - Staff 1 is missing tuberculosis (TB) clearance. POC was submitted to CCL by the POC due date.


The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22. The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
Exit interview was conducted with Dierik Gonzalez, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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
Document Has Been Signed on 11/21/2024 03:41 PM - It Cannot Be Edited


Created By: Joe Katrdzhyan On 11/21/2024 at 03:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BURBANK YMCA HORACE MANN CHILDRENS CENTER
FACILITY NUMBER: 197494850

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2024
Section Cited
CCR
101238(a)

1
2
3
4
5
6
7
Buildings and Grounds. (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will schedule a licensed pest control company to inspect/treat the ant infestation and provide a copy of the invoice to CCL by the POC due date of 11/26/24.

**Civil Penalty of $700 issued**
8
9
10
11
12
13
14
During the visit conducted on 10/31/24 by LPA Katrdzhyan, infestation of ants were observed in the infant classroom top/upper cabinet, where snacks are stored for children in care. Licensee was asked to schedule a licensed pest control company to inspect/treat the ant infestation and provide a copy of the invoice to CCL. The POC was not met. This poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

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:Rita Ramos
LICENSING EVALUATOR NAME:Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2