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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001682
Report Date: 10/15/2020
Date Signed: 10/15/2020 03:44:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SANTILLAN, MARIELAFACILITY NUMBER:
384001682
ADMINISTRATOR:SANTILLAN, MARIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 786-9391
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 6DATE:
10/15/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Mariela SantillanTIME COMPLETED:
03:00 PM
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Licensing Program Analyst, LPA Yee conducted a case management teleconference today. Licensee requested to add a room. Fire clearance approval has been requested. Areas to be used for child care (lower level): one large room, study room next to the large room, bathroom, and backyard. The internal stairwell leading to the upper level is made inaccessible. The garage is made inaccessible. The entire upstairs level is off-limits. Fire extinguishers, smoke detectors, carbon monoxide detectors are present. The hours of operations are Monday - Friday, 8:30 am - 3:00 pm.

Study room approval is pending on fire clearance.

This report was reviewed with Licensee and a copy of this report must be available for public review upon request.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020
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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