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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618203
Report Date: 10/26/2023
Date Signed: 10/26/2023 09:43:22 AM

Document Has Been Signed on 10/26/2023 09:43 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:UGSANG, MARILOUFACILITY NUMBER:
343618203
ADMINISTRATOR:UGSANG, MARILOUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 283-1464
CITY:MATHERSTATE: CAZIP CODE:
95655
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Marilou UgsangTIME COMPLETED:
10:00 AM
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Licensing Program Analysts (LPA) Gagandeep Singh met with licensee, Marilou Ugsang, for an annual inspection. The purpose of the inspection was explained. Licensee lives in two story home. During the inspection, there were no day care children present. All adults living or working in the home have criminal background check on file. Licensee provides day care from Monday to Friday between 8:30 AM to 6:00 PM.

LPA inspected the day care areas with the licensee. Day Care Areas: Kitchen, Dining area, Living room, Hallway, Bathroom in hallway. Off limit areas: Entire second floor, Laundry room, Garage and Backyard. LPAs observed all the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. LPA observed there is an inground pool in the back yard and pool has Department approved fence all around it. LPA observed the fence has gate and is locked to keep the pool inaccessible for the children. As per licensee, there is no firearm or weapon in the house. Fireplace has metal screen making it inaccessible for the children. The house is in good repair and free of hazards with proper temperature and ventilation. There are carbon monoxide detector and smoke detector and fully charged fire extinguisher in the house. There is a variety of age appropriate toys in the house.

LPA reviewed the facility records. LPA observed licensee has License and other required documents posted in the child care areas. Licensee has record of training of preventive health and CPR card valid until December 2023. Licensee is aware that the fire or emergency drills must be conducted at least once every six months and must be logged. Licensee has a log in place and per log, last drill was conducted in August 2023. LPA observed a well maintained children roster on file. Licensee has completion certificate for the Mandated reporter training. Per certificate, the training is valid until February 2024. Licensee is aware that the training must be renewed every two years.
See next page for continuation ................
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: UGSANG, MARILOU
FACILITY NUMBER: 343618203
VISIT DATE: 10/26/2023
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed with licensee the safe sleep regulations and the Child Care Licensing Safe Sleep web page at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed and provided to the licensee. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
LIC809 (FAS) - (06/04)
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