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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601596
Report Date: 09/25/2019
Date Signed: 09/25/2019 12:52:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:URBANK FAMILY DAY CAREFACILITY NUMBER:
191601596
ADMINISTRATOR:URBANK, LYNDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 283-7231
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:12CENSUS: 4DATE:
09/25/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Lynda UrbankTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA’s) Stella Gutierrez and Lourdes Castellanos met with Lynda Urbank, Licensee, on 9/25/2019 @ Approximately 8:52 AM for the purpose of an 3 year Annual Random Inspection. Upon arrival, LPA observed 4 children (1 INFANT, 2 Toddlers and 1 Pre-Schooler) being supervised by licensees Lynda Urbank and Husband, Noel Adams. All adults were fingerprinted and associated to the facility. LPA’s toured and inspected all rooms identified in facility sketch. Hours of operation are from 6:30 am to 5:30 pm, Monday through Friday.

This is a single-story dwelling which consist, three-bedroom, two-bathroom home with kitchen/dining, living room, and detached garage with a backhouse. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include licensee and spouse with their daughter (minor). The home has a no fireplace. off-limits area includes the following: living room (left when entering home), the kitchen/dining area to the right when entering home. (The Licensee has installed a child safety gate in hallway so that children do not access to living room/dining and kitchen area. Bathroom #2 (right when passing kitchen). .

Outside: Backhouse, left side of house, garage, dog pen area, driveway, front yard.
Children’s accessible areas are the bathroom #1 (in hallway on the left directly across from bathroom #2) The Bathroom is with cabinet safety latch and free from hazards. Playroom located in the back of home with refrigerator with food and stored properly. Children’s napping area is in bedroom #3 age appropriate napping equipment and materials available and inspected. Child #1 occasionally naps in bedroom #1 inside an age appropriate crib and bedding. Outside: Main play area (left back house) play area (right side of home in front of detached garage with fence)

LPA’s, Gutierrez and Castellanos observed age appropriate toys, learning materials, games and activities for children in care. All furniture was found in good repair, clean, and without hazards. The facility was

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: URBANK FAMILY DAY CARE
FACILITY NUMBER: 191601596
VISIT DATE: 09/25/2019
NARRATIVE
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inspected inside for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under sink with latch) and above washer and dryer in main play area, and hazardous items (sharp knives in kitchen only) that can pose a danger to children.

Inspection of the outdoor play area was conducted at approximately 9:30 am Fencing around the perimeter. . The backyard is under construction and LPA’s observed construction tools that can pose a danger that were accessible to the children. Tools included and pictures taken of, Cement mixer, electric saw, screws/nails, shovels, rakes, power drill in main play area. LPA’s observed a knife with no blade near construction tools. Tools were removed during todays visit. Back gate door to dog pen was removed and accessible to children. Door in dog pen was latched back on during todays visit. Main play area equipment not safe from splinters. Right side play area (fenced) LPA’s observed electric generator and rake that was accessible to the children. During todays visit these items were made inaccessible.

LPA observed licensee’s Pediatric First Aid and Adult, Child and Infant CPR to be current (expires on 10/2020). LPA observed a working smoke detector, operable carbon monoxide detector and 2A10-BC fire extinguisher (serviced last March 2019) Children and staff files were reviewed and incomplete. Facility file was reviewed and incomplete. LPA provided required forms to complete Children's records, Facility records and Posted requirement forms.

LPA discussed capacity limitations, new car seat law, personal rights, Notification of Parent's Rights revised 12/06, inspection authority & agency's consultative role. Smoking is prohibited on the premises when children are present. The LPA also discussed earthquake safety and necessity of drills every 6 months. The applicant was also informed that all adults living in or having access to day care children in the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of $100 /day per uncleared adult will be assessed.

The facility is not currently providing IMS. Incidental Medical Services (IMS) policy was discussed with the Licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. LPA obtained a copy of the facility's IMS Plan. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.html

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: URBANK FAMILY DAY CARE
FACILITY NUMBER: 191601596
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/25/2019
Section Cited

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The home shall be free from defects or conditions which might endanger a child...
This requirement was not met as eveidence by: Based on observations at 9:30am LPA's observed hazards in main play area that can pose an immediate danger to children in care. Picture were taken.

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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: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2019
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: URBANK FAMILY DAY CARE
FACILITY NUMBER: 191601596
VISIT DATE: 09/25/2019
NARRATIVE
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Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

An exit interview was conducted and a copy of this report along with the notice of site visit were provided to Lynda Urbank, licensee.

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: URBANK FAMILY DAY CARE
FACILITY NUMBER: 191601596
VISIT DATE: 09/25/2019
NARRATIVE
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FORMS TO BE POSTED
· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster

Required forms were not posted during today's visit. .

The following were also discussed with licensee:



Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:

California Department of Social Services | Community Care Licensing Division


300 Continental Blvd., Suite 290-A
El Segundo, CA 90245

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university.

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: URBANK FAMILY DAY CARE
FACILITY NUMBER: 191601596
VISIT DATE: 09/25/2019
NARRATIVE
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The licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541.
Email Address: childcareadvocatesprogram@dss.ca.gov

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com
Licensees completed mandated reporter training on 10/25/2018.

Safe Sleep Links:
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx


NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

SIDS & SHAKEN BABY SYNDROME INFORMATION (discussed) flyer provided.


LPA provided safe sleep flyer and discussed safe sleep practice. Infants must be placed on their backs and must be physically checked every 15 minutes to gauge temperature and ensure they are breathing.

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: URBANK FAMILY DAY CARE
FACILITY NUMBER: 191601596
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2019
Section Cited

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Each family child care home shall conduct fire drills and disaster drills.... This requirement was not met as evidence by: Based on observations the licensee failed to conduct fire/diasters
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drills. This posed a potential health and safety to children in care.
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Type B
10/25/2019
Section Cited

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The licensee shall maintain, in each child's record, the signed and dated notice form required ...The licensee shall maintain, in each child's record, a copy of the emergency information card... this requirement was not met. Based on observation. The Licensee failed to
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have a complete documents for Child #1, Child #2, Child #3 and Child #4. This poses a potential health and safetly risk to children in care.
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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: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2019
LIC809 (FAS) - (06/04)
Page: 7 of 7