198016880-2-16-2022-33-CC-CGUA-CC7UXV-20220304145857

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198016880
Report Date: 02/16/2022
Date Signed: 02/16/2022 09:46:39 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/08/2021 and conducted by Evaluator Judy Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20211208082428

FACILITY NAME:	UGALDE FAMILY CHILD CARE		FACILITY NUMBER:	198016880
ADMINISTRATOR:	UGALDE, ANDREA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 284-2888
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90057
CAPACITY:	14	CENSUS: 2	DATE:	02/16/2022
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Andrea Ugalde		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Licensee is not present in the home.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced site inspection on this date to conclude the investigation for the above complaint allegation. LPA met with Licensee, Andrea Ugalde. The Licensee's father, Alfredo Ugalde, was present in the home. There were 2 children present in the home. There were 4 dogs and 3 cats indoors. The dogs were caged upon arrival.

During the course of this investigation LPA conducted interview with Licensee, RP and other witnesses. A copy of the facility roster was requested. LPA also requested paperwork for dogs in the home. LPA obtained a copy of Pathways contract for child #1.
During the course of interviews conducted, there were no disclosures made. Although the allegations may have happened or are valid there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.
A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted with Licensee, Andrea Ugalde. Appeal Rights explained and provided.
The Licensee refused to sign the report at the time of inspection.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

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

LIC9099 (FAS) - (06/04)

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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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/08/2021 and conducted by Evaluator Judy Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20211208082428

FACILITY NAME:	UGALDE FAMILY CHILD CARE		FACILITY NUMBER:	198016880
ADMINISTRATOR:	UGALDE, ANDREA		FACILITY TYPE:	810
ADDRESS:	122 S. BENTON WAY		TELEPHONE:	(213) 284-2888
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90057
CAPACITY:	14	CENSUS: 2	DATE:	02/16/2022
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Andrea Ugalde		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff did not provide adequate supervision to day care child resulting in an injury.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced site inspection on this date to conclude the investigation for the above complaint allegation. LPA met with Licensee, Andrea Ugalde. The Licensee's father, Alfredo Ugalde, was present in the home. There were 2 children present in the home. There were 4 dogs and 3 cats indoors. The dogs were caged at the time of arrival.

During the course of this investigation LPA conducted interview with Licensee, RP and other witnesses. LPA obtained photos of the child’s injury. A copy of the facility roster was requested. LPA also requested paperwork for dogs in the home. LPA obtained a copy of Pathways contract for child #1.

During the intial inspection on 12/10/21 the Licensee admitted that at the time of the incident she was right in front of the child and the dog. The Licensee also admitted that after the child was knocked over she still did not place the dog in the cage nor did she spray the dog because she thought the dog was not being aggressive. This fall could have been prevented.

*REPORT CONTINUES ON NEXT PAGE

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 33-CC-20211208082428

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: UGALDE FAMILY CHILD CARE	FACILITY NUMBER: 198016880
	VISIT DATE: 02/16/2022

NARRATIVE

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During this inspection, the Licensee was asked for a written Declaration to describe what occurred at the time of the incident but the Licensee refused to complete the Declaration.

Based on the available information, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations,(Title 22, Division 12 & Chapter Number 1), is being cited on the attached LIC. 9099D.

Upon receipt of this report, the licensee shall post any licensing report documenting a type “A” citation and/or a substantiated complaint. 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 LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided.

A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted with Licensee, Andrea Ugalde, whom refused to sign this report Appeal Rights explained and provided.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 33-CC-20211208082428

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: UGALDE FAMILY CHILD CARE	FACILITY NUMBER: 198016880
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/16/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/17/2022 Section Cited HSC 102423(a)(2)	1 2 3 4 5 6 7	Personal Rights To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by, during the initial inspection on 12/10/21 the Licensee admitted that at the time of the incident she was right in front of the	1 2 3 4 5 6 7	The Licensee indicated during this inspection that she is not going to complete a declaration and is not going to admit that an injury occurred. The Licensee indicated that she will appeal the citation. The Licensee is refusing to sign the report.
	8 9 10 11 12 13 14	child and the dog. The Licensee also admitted that after the child was knocked over she still did not place the dog in the cage nor did she spray the dog because she thought the dog was not being aggressive. This was an immediate risk to the health and safety of 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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

LIC9099 (FAS) - (06/04)

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