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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002462
Report Date: 12/15/2021
Date Signed: 12/15/2021 10:59:04 AM

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:AUBIN, MARYLENE C.FACILITY NUMBER:
384002462
ADMINISTRATOR:AUBIN, MARYLENE C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 533-2426
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:14CENSUS: 1DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee, Marylene AubinTIME COMPLETED:
11:15 AM
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On December 15, 2021 at 8:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual, required inspection. LPA met with Licensee, Marylene Aubin and explained the purpose of the inspection. At the start of the inspection, no enrolled children were present in the home. All adults living in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 8:30am to 5:15pm.

Licensee rents the home which is a two level, family home. The home consists of an upper level and lower level area. Upper level of home consists of two bedrooms, one bathroom, living room, dining room, and kitchen. The lower level of the home consists of one bedroom, one bathroom, backyard area and garage. Day care is operating on upper level of the home. The DAY CARE AREAS are living room, dining room, kitchen, bathroom #1, and bedroom #2 (main classroom/nap room). The OFF-LIMITS AREAS is bedroom #1 (upper level), bedroom #3 (lower level), bathroom #2 (lower level), and garage. All off-limit areas are inaccessible to children in care by child safety gates and/or locked doors.

At approximately 8:45am, LPA toured day care areas of home with Licensee. LPA observed home to be in good repair with proper temperature and ventilation. Facility is a French, Montessori Immersion program. LPA observed a variety of age appropriate materials and equipment that were in good condition and are consistently changed. All accessible electrical outlets were properly covered. There were no pools, spas or bodies of water on the property. The entire backyard is enclosed with an least 5ft high fence. The backyard is equipped with appropriate outdoor toys and equipment that were in good working condition. All cleaning supplies, poisons and other chemicals were stored inaccessible to children on high shelves. Accessible drawers and cabinets in kitchen are properly locked with child safety locks.

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SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: AUBIN, MARYLENE C.
FACILITY NUMBER: 384002462
VISIT DATE: 12/15/2021
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At approximately 9:30am, enrolled child (preschool age) arrived to facility. Present during inspection now includes Licensee and one enrolled child.

There was a working smoke detector and carbon monoxide detector, fully charged fire extinguisher and a working telephone on site. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home. LPA reviewed eight enrolled children's records which included a record of emergency identification information on file. Licensee's Pediatric First Aid/CPR is current and will expire 01/2022. Last emergency drill was conducted 09/09/2021. Emergency drills are conducted at least once every six months and are properly logged.

During Inspection:
- Licensee was given information regarding PIN 20-24-CCP Safe Sleep Regulation, CA DPH Guidance for Use of Face Coverings and Receiving Important Updates.
-Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
-Licensee was reminded, frequent Visitors or Volunteers must be fingerprint cleared and associated to facility.
-Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com.
-Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
-Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00am - 5:00pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

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: www.ada.gov/childqanda.htm.

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SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 2 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: AUBIN, MARYLENE C.
FACILITY NUMBER: 384002462
VISIT DATE: 12/15/2021
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

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

An exit interview conducted and report was reviewed with the licensee, Marylene Aubin.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
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