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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016880
Report Date: 08/13/2019
Date Signed: 08/13/2019 01:49:59 PM

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:UGALDE FAMILY CHILD CAREFACILITY NUMBER:
198016880
ADMINISTRATOR:UGALDE, ANDREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 284-2888
CITY:LOS ANGELESSTATE: CAZIP CODE:
90057
CAPACITY:14CENSUS: 12DATE:
08/13/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Andrea Ugalde, LicenseeTIME COMPLETED:
02:10 PM
NARRATIVE
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AN ANNUAL REQUIRED INSPECTION
Licensing Program Analyst, Janeth Chavez, conducted an unannounced annual required site inspection to ensure the health & safety standards as required by regulations governing family child care homes. Upon arrival, LPA met with Licensee, Andrea Ugalde who guided LPA on a tour of the facility. There are 12 (2 infants) children present upon LPA’s arrival. Individuals residing in the home are licensee, licensee’s parents and adult sister. All adults living in the home have obtained a Background Criminal Record clearance. Licensee’s hours of operation are 6am-6pm. There are no dual licenses in the home as per licensee.

The home is a one story, 3-Bed, 2-Bath home. The following areas are used for day-care: Living Room and Dining Room, & bathroom (adjacent to dining room). Off limit areas include: All 3 bedrooms & 1 bathroom, kitchen, backyard (fenced), front yard, and attached garage. Licensee stated that the backyard is currently inaccessible to children as the attached garage is being cleaned out. The children will not be using the backyard until 08/19/2019. Licensee was advised to have all off-limit areas inaccessible to day care children during hours of operation.

Licensee has the Parent’s Rights poster and other appropriate forms posted on wall in the living room. First Aid/CPR certificate are valid thru 04/2021 for licensee and assistant. Licensee stated she has practiced fire/emergency drills with day-care children on 07/02/19, providing LPA with disaster drill log. Licensee uses cell phone and there are two digital land lines in the home.

Detergents and cleaning supplies were inaccessible and are kept latched under the kitchen sink. Fire extinguisher is fully charged and was purchased in July 2019. There is an operational smoke detector and carbon monoxide in the dining room. Report Continues on Next Page 1 of 3

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
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 5
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: UGALDE FAMILY CHILD CARE
FACILITY NUMBER: 198016880
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2019
Section Cited
CCR
102417(g)(10)
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Operation of A Family Child Care Home

A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c).
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Licensee removed the baby bouncer and the jumper and placed them in the attached garage area (an off-limit area) during the inspection.
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This requirement is not met as evidenced by LPA observing a baby bouncer and jumper inside of a play pen located in the living room area. This is a potential health and safety risk to the children in care.
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Type B
08/27/2019
Section Cited
HSC
1597.622
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(Health and Safety) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Licensee stated she will obtain proof of immunizations for herself, Alfredo and Diana to the Department by the POC due date of 08/27/19.
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This requirement is not met as evidenced by licensee not been able to provide proof of vaccinations during the inspection. This is a potential health and safety 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: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: UGALDE FAMILY CHILD CARE
FACILITY NUMBER: 198016880
VISIT DATE: 08/13/2019
NARRATIVE
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· A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home. Licensee was advised to make sure the assistants are actively involved with day care children.

Deficiencies were cited in accordance with California Code of Regulations Title 22. See 809-D.

LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov
Email Address:

The Notice of Site Visit (LIC 9213) – 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 Licensee, Andrea Ugalde. Appeal rights discussed and explained.
End of Report Page 3 of 3
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: UGALDE FAMILY CHILD CARE
FACILITY NUMBER: 198016880
VISIT DATE: 08/13/2019
NARRATIVE
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 The home has electrical outlet covers throughout and maintains a First Aid Kit. There are adequate age appropriate toys, books, and games. There are no firearms present on the premises as stated by licensee. LPA did not observe any pools, spas or other bodies of water.

LPA inspected the backyard and found the garage door locked. There are two pets in the home (1 dog and 1 cat). Licensee was advised to keep the pets isolated from day care children. The dog has its own dog run. LPA observed a baby bouncer and a jumper inside a play pen located in the living room area. LPA informed licensee that these items are not permitted in a family child care home. Licensee and assistant could not provide proof of SB792 immunization requirement and stated that they have not taken AB1207 Mandated Reporter Requirement. This is a potential health and safety risk to the children in care. Children’s roster and files were reviewed and are complete.

The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.



· LPA reviewed LIC 311D with licensee, reminding her of required forms. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. LPA observed two infants and advised licensee to move the play pen away from the window. Licensee moved the play pen from the window during inspection.

· 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

Report Continues on Page 2 of 3
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: UGALDE FAMILY CHILD CARE
FACILITY NUMBER: 198016880
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2019
Section Cited
HSC
1596.8662
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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child 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
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Licensee stated she will take the mandated reporter training herself and all of her assistants and will provide proof to the Department by the POC due date of 08/27/19.
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following the date on which he or she completed the initial mandated reporter training. ***This requirement is not met as evidenced by licensee not being able to provide proof or copies of the ceritificate during inspection. This is a potential health and safety risk to the 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: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5