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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016880
Report Date: 06/29/2021
Date Signed: 06/29/2021 11:19:48 AM

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: 2DATE:
06/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Andrea UgaldeTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced Required 1 year inspection. LPA met with licensee, Andrea Ugalde, who guided analyst on a tour of the facility. The licensee's father, Alfredo Ugalde, Licensee's mother Diana Ugalde and Licensee's sister, Diana Ugalde were present in the home. There were 2 children in the home. Licensee states that there are currently 3 children enrolled.
Family members residing in the home are 4 adults (criminal record clearances on file). There are 4 large dogs on the property, paperwork is available.

The home is a one story, 3 Bedrooms, 2 Bathrooms, kitchen, living room, dining area, front and back yards and detached garage. The following areas are used for day-care: Living Room, Dining Room, backyard, bathroom (adjacent to dining room). Off limit areas include: All 3 bedrooms & 1 bathroom, kitchen, front yard, and detached garage. Licensee was advised to have all off-limit areas inaccessible to day care children during hours of operation.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating (central air) for safety and comfort. There were safe toys, play equipment and materials observed for children. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in all areas of the home. The licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination lock.


LPA observed and inspected sleeping equipment for infants. Licensee does not have any infants under age 2 at this time. LPA observed play yard for each infant who is unable to climb out of the crib or play yard. All equipment meets the US Consumer Product Safety Commission safety standards. LPA observed that play yards do not hinder the entrance or exit to and from the space they are sleeping in. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping.

*REPORT CONTINUES ON THE NEXT PAGE
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
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 4
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: 06/29/2021
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LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was explained and issued to the Licensee. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained.

Per licensee there are no bodies of water on the premises. Licensee does have a small firearm in the home, which is kept in a locked safe, LPA observed firearm in safe. Per Licensee she does not have any ammunition at this time. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged, however, it has not been serviced yearly as required; this is a potential risk to the health and safety of children in care. Smoke detector and carbon monoxide detector in the dining room were tested and are in operable condition. The licensee does not have current Pediatric First Aid and CPR, expired 04/2021; this is a potential risk to the health and safety of children in care.

Incidental Medical Services (IMS) policy was discussed. Per Licensee there are no children on medication. 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

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee. Licensee has required immunization records on file.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers Licensee completed training on 08/25/2019.

*REPORT CONTINUES ON NEXT PAGE
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: 06/29/2021
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The following was discussed:
· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· The Licensee shall be present in the home and shall ensure that children are supervised at all times.
· Children shall not be left in park vehicles.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided.
· Car seats shall only be used for transportation purposes and shall not be used for sleeping.
· All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
· When a child shows signs off illness, they will be separated from other children until the nature if the illness is determined.

The licensee’s email address was obtained during this visit. The licensee was advised that email is public information.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

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.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

*END OF REPORT
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 06/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/09/2021
Section Cited

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OPERATION OF A FAMILY CHILD CARE HOME
The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: Fireplaces and open-face heaters shall be screened to prevent access by children.
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The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
This requirement was not met as evidenced by LPA observing that the Fire extinguisher has not been serviced in the last year as required. Licensee states it was purchased early 2020.
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Type B
07/30/2021
Section Cited

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Personel Requirements
A licensee of a large family day care home shall ensure that at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation shall be available at all times when children are present at the facility, or
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when children are off-site of the facility for facility activities....
This requirement ws not met as evidenced by Licensee file review. The licensee does not have current Pediatric First Aid and CPR, expired 04/2021; this is a potential risk to the health and safety of 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) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4