384002462-11-7-2022-05-CC-CQUO-CKXPR8-20221107103218

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002462
Report Date: 11/07/2022
Date Signed: 11/07/2022 10:32:44 AM

Document Has Been Signed on 11/07/2022 10:32 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
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 FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY:	14	CENSUS: 5	DATE:	11/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Marylene Aubin		TIME COMPLETED:	10:45 AM

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	On November 7, 2022 at approximately 8:15am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Marylene Aubin, and explained the purpose of the inspection. All adults working in the home have fingerprint clearance on file. Present during LPA's visit included 4 enrolled children (all preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. Hours of operation are Monday to Friday from 8:30am to 5:15pm. Licensee lives in the home alone, which is a multi-level home. The home consists of two levels, upper and lower area. The upper level of the home consists of two bedrooms, one bathroom, living room, dining area, and kitchen. The lower level of the home consists of one bedroom, one bathroom, backyard area and garage. The DAY CARE AREAS are located on the upper level of the home that includes the living room, dining area, kitchen, bathroom #1, bedroom #2 (main classroom) and backyard area. The OFF LIMIT AREAS are bedroom #1 (upper level of home), bedroom #3 (lower level), bathroom #2 (lower level), and garage. Off limit areas are made inaccessible to children by locked doors and/or child safety gates. LPA inspected the home, indoors and outdoors, for health and safety hazards. LPA observed home to be in good repair with proper temperature and ventilation. Home operates as a Montessori, French immeersion program. LPA observed main classroom and living room to have a variety of age appropriate toys and equipment that were in good condition. LPA observed electrical outlets located in day care areas to be made inaccessible by child safety covers and/or blocked by furniture. LPA observed all cleaning supplies, poisons, and other chemicals to be stored inaccessible in home's high shelves and/or locked behind child safety locked cabinets. Home has multiple carbon monoxide and smoke detectors, fire extinguisher and a working phone on site. Phone number listed for licensee is current. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: AUBIN, MARYLENE C.	FACILITY NUMBER: 384002462
	VISIT DATE: 11/07/2022

NARRATIVE

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LPA observed the backyard to include an upper deck and lower backyard area. Backyard area include stair cases that are made inaccessible with gates. LPA observed the deck and backyard area to equipped with age appropriate materials that were in good condition. Licensee has cushioned backyard flooring with tarp and artificial turf. LPA observed lower backyard area to include support posts that were appropriately padded and cushioned. Deck and backyard area were observed to be clean and fully fenced with an at least 4 ft. high fence.

LPA observed required licensing documents to be properly posted in the home, available for review. LPA reviewed 7 children children's records, which were complete. Children's files have a record of emergency identification information on file.

At approximately 9:45am, additional enrolled child (preschool age) arrived to facility. Present during LPA's visit included 5 enrolled children (all preschool age) and licensee.

Licensee's CPR is current and will expire 01/2024. Licensee's Mandated Reporter training is also current and will expire 06/2024. Licensee is aware Mandated Reporter training must be renewed every 2 years and must be maintained for all staff that are hired. Per licensee, there are no weapons or firearms in the home.

Emergency drills are conducted at least once every six months and are properly logged. Last emergency drill was conducted 09/07/2022. Licensee also has proof of safe sleep logs that were maintained for children under 2 years old. Safe sleep logs document the 15 minute time check of when infant was last check on when sleeping.

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
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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022

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: 11/07/2022

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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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Marylene Aubin.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022

LIC809 (FAS) - (06/04)

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