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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016880
Report Date: 12/11/2019
Date Signed: 12/11/2019 04:33:44 PM

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: 5DATE:
12/11/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Andrea Ugalde, LicenseeTIME COMPLETED:
04:50 PM
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Licensing Program Analyst, Janeth Chavez, conducted an unannounced Case Management inspection to amend a report issued on 12/06/2019. LPA was greeted by licensee, Andrea Ugalde. Present during inspection are 5 daycare children, licensee and licensee's mom. All adults present have obtained criminal record clearance or exemption. There are no deficiencies cited on this inspection.

Exit interview conducted with Andrea Ugalde. Appeal rights discussed and explained.

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

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
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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