197493287-10-1-2019-54-CC-CGUA-BH4MAF-20191019092616

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197493287
Report Date: 10/01/2019
Date Signed: 10/01/2019 09:52:10 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2019 and conducted by Evaluator Judy Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20190814104301

FACILITY NAME:	URIZAR FAMILY CHILD CARE		FACILITY NUMBER:	197493287
ADMINISTRATOR:	URIZAR, SANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 815-5336
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90062
CAPACITY:	14	CENSUS: 5	DATE:	10/01/2019
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Sandra Urizar		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff handled child in a rough manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Judy Mora conducted an unannounced inspection to conclude the investigation for the above complaint allegation. Visit was conducted in Spanish. LPA met with Sandra Urizar. There were 05 children present during this visit.

During the course of the investigation LPA conducted interviews and reviewed records. Disclosures were made in regards to staff #4 handling child #8 in a rough manner. Staff #4 snatched a toy airplane away from child #8 and caused a scratch on child #8's hand. Child #8 is no longer enrolled at the facility. Based on the interviews conducted and the available information, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations were(Title 22, Division 12& Chapter Number 1), are being cited on the attached LIC. 9099D.

This poses an immediate Health and Safety risk to clients in care.

*REPORT CONTINUES ON NEXT PAGE

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 54-CC-20190814104301

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: URIZAR FAMILY CHILD CARE	FACILITY NUMBER: 197493287
	VISIT DATE: 10/01/2019

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
26
27
28
29
30
31
32

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.

A copy of the the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided to Licensee.

Exit interview was conducted with Licensee. Appeal rights and procedures were explained and provided.

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 54-CC-20190814104301

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: URIZAR FAMILY CHILD CARE	FACILITY NUMBER: 197493287
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/01/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied: Appeal Not Submitted Timely Type A 10/02/2019 Section Cited CCR 102423(a)(4)	1 2 3 4 5 6 7	Personal Rights To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing,	1 2 3 4 5 6 7	Licensee states that her mom will no longer come to help her. Licensee wrote statement in regards to correcting deficiency. LPA obtained statement.
	8 9 10 11 12 13 14	medication or aids to physical functioning. This requirement was not met as evidenced by interviews conducted and dosclosures made during interviews. Staff #4 handled child #8 in a rough manner. This was an immediate risk to the health and safety to children 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: Katherine Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

LIC9099 (FAS) - (06/04)

Page: 3 of 3