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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618203
Report Date: 10/18/2019
Date Signed: 10/18/2019 12:17:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:UGSANG, MARILOUFACILITY NUMBER:
343618203
ADMINISTRATOR:UGSANG, MARILOUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 283-1464
CITY:MATHERSTATE: CAZIP CODE:
95655
CAPACITY:14CENSUS: 4DATE:
10/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Marilou UgsangTIME COMPLETED:
12:17 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elvira Sierra met with licensee, Marilou Ugsang for an unannounced annual random inspection. Facility hours of operation are M-F 08:00 AM to 05:00 PM. Upon arrival today's census was 4 preschool children. All adults living in the home have obtained a criminal record clearance and is on file with Licensing Office. Licensee understands she must be present 80% of operating hours and must submit a change of location application if she relocates.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include; The entire upstairs, laundry room, garage. Home has a working phone, functioning smoke and carbon monoxide detector and a 2A10BC fire extinguisher that meet standards established by the State Fire Marshal. Stairs at the home are properly barricaded and LPA advised Licensee to make sure gate is always closed and secure. Licensee stated that the fireplace in the living room is never used during daycare hours and is barricaded. Licensee stated there are no weapons in the home. Toxic and hazardous items; such as cleaning compounds and medications are inaccessible to children. Home has a pool with a self closing and self latching mechanism that is properly working and the gate swings open away from the pool. Home is fenced for supervision.
Children’s files were reviewed and contained current immunization and emergency contact ID information. A current roster is being maintained and fire and disaster drills are conducted at least once every six month and are properly log. Current pediatric CPR and first aid certification was verified and expires on 01/2020.

LPA discussed with licensee regulation AB 1207- California Child Care Worker: Mandated Reporter Training. The licensee must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be could at: mandatedreporterca.com.

LPA also discussed the Smoking Probation Regulation (AB 1819-Smoking Prohibition), the Nutritious Beverage Act and the Incidental Medical Services (IMS) policies with the licensee.

Report continued on subsequent page 809C...
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: UGSANG, MARILOU
FACILITY NUMBER: 343618203
VISIT DATE: 10/18/2019
NARRATIVE
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This provider is currently not providing IMS services to children in care. 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.
Licensee was updated on immunization requirements from the Department of Public Health(CDHP) that will become effective July 1, 2019. Additional information and resources can be found on the https://www.shotsforschool.org website.

LPA advised the licensee on Safe Sleep Practices and SIDS; She stated she uses cribs for sleeping infants and understand infants cannot sleep in car seats, swings or other items not intended for sleeping. Safe Sleep in Child Care publication was provided.

Lead Poisoning Facts Information Flyer was provided and Licensee was advised that beginning January 1, 2019 a new law (AB 2370) requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.
LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.



In the areas that were evaluated, no deficiencies were observed at the time of the inspection. -
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: UGSANG, MARILOU
FACILITY NUMBER: 343618203
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2019
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. This condition was not met as evidence by;LPA observed the left portion of the fence to have loose boards. This is a violation that can pose a potential risk to children during outdoor activities.

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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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3