<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618203
Report Date: 12/09/2019
Date Signed: 12/09/2019 03:02:35 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: DATE:
12/09/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Marilou UgsangTIME COMPLETED:
03:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Elvira Sierra met with Marilou Ugsang for a Proof of Correction (POC) Inspection to verify correction of deficiency that was cited on 10/14/19. Upon arrival LPA observed 4 children present with Licensee and assistant.

LPA observed the loose boards on the left portion of the fence had been repaired. Fence is in compliance with Title 22 regulations and Health and Safety code, Deficiency cited is cleared on today's inspection.

No Title 22 Deficiencies observed in the areas that were evaluated. This report was reviewed and discussed with Licensee and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and Licensee understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019
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 1