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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016880
Report Date: 12/10/2021
Date Signed: 12/10/2021 10:32:07 AM


Document Has Been Signed on 12/10/2021 10:32 AM - 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 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: 3DATE:
12/10/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Andrea UgaldeTIME COMPLETED:
10:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced Case Management inspection on this day. Met with Licensee, Andrea Ugalde. There were 3 children parent in the home.

The purpose of this visit was to ensure that the Licensee is in compliance with Title 22 regulations.

Licensee did not have a current roster on file. LPA requested a roster for the last 3 months.

LPA observed that the Licensee does not have current First Aid & CPR at this time.

LPA also observed that assistants Diana and Alfredo Ugalde also do not have current Pediatric First Aid and CPR and they do not have the Mandated Reporter Training certificate on file.

The deficiencies listed on the following page was observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809d.

Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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

Exit interview was conducted with Licensee. Appeal rights explained & provided.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2021
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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Document Has Been Signed on 12/10/2021 10:32 AM - 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: UGALDE FAMILY CHILD CARE

FACILITY NUMBER: 198016880

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 12/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
01/10/2022
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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Request Denied
Type B
12/13/2021
Section Cited

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Operation of a Family Child Care Home
Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement was not met as evidenced by Licensee admitting that she does not have a current roster. This is a potential risk to the health and safety of children in care.
Request Denied
Type B
01/10/2022
Section Cited

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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 following the date on which he or she completed the initial mandated reporter training.
This requirement was not met as evidenced by file review. Licensee's assitants do not have the mandated reporter training on file.
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: 12/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2021
LIC809 (FAS) - (06/04)
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