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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601596
Report Date: 11/13/2019
Date Signed: 11/13/2019 10:30:29 AM

COMPREHENSIVE INSPECTION
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: 3DATE:
11/13/2019
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lynda UrbankTIME COMPLETED:
10:45 AM
NARRATIVE
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On 11/13/2019 at 9:30 AM Licensing Program Analysts (LPA) Stella Gutierrez arrived at the licensed facility for the purpose of conducting Case Management/ Plan of Correction (POC) inspection to ensure Licensee is in compliance of Title 22 regulations. LPA met with Licensee, Lynda Urbank who guided the LPA on a tour of the facility. Upon arrival LPA observed 3 children ages 3-4 with one staff. Licensee is operating within the capacity and ratio of the license.

LPA, Gutierrez toured the facility inside and out. The following was observed during today’s visit.
All areas were clean and free from any potential or immediate hazards that can pose a danger to children in care. Licensee was reminded by LPA, Gutierrez to inform our office of any changes with the exterior or interior of the facility grounds and to send in an updated sketch (LIC 999) with the changes to the licensing office in El Segundo, California. All posting requirements were posted near kitchen area including, Facility License, Emergency Disaster Plan, Parents rights poster and updated facility sketch.

Plan of Correction documents received via postage mail on November 4, 2019 included:
1. LIC 610A Updated emergency disaster Plan and Fire Drill Log Plan of Correction that was requested on 9/25/2019.
2. LIC 999 Updated facility sketch
3. Picture of refurnished outdoor equipment (Picture was too small to clear LPA’s request. New picture was taken today by LPA, Gutierrez and placed in file)
4. LIC 500 Updated facility roster with all children enrolled. (Licensee had a copy ready for LPA to review for verification)
5. Copy LIC 9224 in each child’s file in forming parents of the children in care of Deficiencies cited on 9/24/2019.

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

DATE: 11/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: URBANK FAMILY DAY CARE
FACILITY NUMBER: 191601596
VISIT DATE: 11/13/2019
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Documents that were requested to clear Plan of Correction and deficiency type B cited on 9/24/2019 were not received. The following corrections were observed during today's inspection:


1. A completed LIC 700 (Emergency info card) for Child #1, Child #2, Child #3 and Child #4 were observed to be placed in files.


Plan of Corrections cleared today. No deficiencies were cited during this inspection.

An exit interview was conducted, and a copy of the report was given to licensee, Lynda Urbank.





















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

DATE: 11/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019
LIC809 (FAS) - (06/04)
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