197493287-12-6-2022-54-CC-AMOY-CLUT27-20221206132015

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493287
Report Date: 12/06/2022
Date Signed: 12/06/2022 01:20:31 PM

Document Has Been Signed on 12/06/2022 01:20 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

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:	12/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Sandra Urizar, Licensee		TIME COMPLETED:	01:30 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection in Spanish on this date. Upon arrival at 10:20am LPA met with Sandra Urizar. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. Licensee provided tour of facility. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee the hours of operation are Monday-Friday 6:00am - 6:00pm. There were 5 children present. Also present was licensee's spouse who assists with the daycare. All adults present have been cleared and associated. Individuals residing in the home were discussed and noted.

This is facility is located in the rear of a multi family unit complex. The home consists of five (5) bedrooms, two bathrooms, kitchen, living room, and backyard.

Per licensee, the areas used by children include: one bedroom and one bathroom, living room, and back yard.

Off limit areas are: Kitchen, Four (4) bedrooms, one (1) bathroom, gated dog run on the side of home. There are safety gates to the kitchen to prevent access by children in care. The off limit bedroom are observed with closed with safety door knobs. One bedroom in hallway is used to access the backyard, Per licensee, children are supervised and bedroom is maintained free from hazards. Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. The licensee provides food for children in care.

LPA observed the facility license posted in the living room. LPA provided licensee with the Publication (PUB) 394- Notification of Parent Rights - in Spanish and English and Licensing Form (LIC) 9148- Earthquake Preparedness form to post in prominent location. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: URIZAR FAMILY CHILD CARE	FACILITY NUMBER: 197493287
	VISIT DATE: 12/06/2022

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The home has a wall heater that is barricaded and uses Ceiling fans for ventilation. Licensee was reminded to ensure the home is comfortable for children in care.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged, purchase receipt was not available for review, Licensee was reminded that fire extinguisher needs to be serviced or replaced yearly. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that cleaning compounds are in kitchen inaccessible to children. The bathroom that children use is located in the bedroom and observed to be clean and free of hazards.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.

Per Licensee there are no firearms or weapons stored in the home. Per licensee there are 2 dogs in the home. LPA observed a medium sized dog in an enclosed dog run on side of the home.
Isolation area for sick children waiting to be picked up is in living room, away from the other children.

Per licensee and based facility roster review, there are no infants currently in care. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. The licensee has fruit trees in back yard and was advised to make sure the fruit is removed regularly to avoid falling on children and avoid attracting vermin. LPA Facility does not have a pool or similar bodies of water.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: URIZAR FAMILY CHILD CARE	FACILITY NUMBER: 197493287
	VISIT DATE: 12/06/2022

NARRATIVE

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Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. Staff #2 is missing the Mandated Reporter Certificate.

LPA advised licensee to stay current with COVID-19 recommendations, precautions and procedures.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on the LPA's observations and records review the following deficiency will be cited today in accordance with California Title 22 Regulations

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Sandra Urizar

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/06/2022 01:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 12/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in Staff #2 did not complete the Mandated Reporter Training certificate which poses a potential health, safety or personal rights risk to persons in care. MandatedReporterca.gov
	POC Due Date: 12/20/2022
	Plan of Correction
1 2 3 4	Per licensee, Staff #2 will complete the Mandated Reporter and send proof of completion to LPA via email by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

LIC809 (FAS) - (06/04)

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