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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004301
Report Date: 08/25/2021
Date Signed: 08/25/2021 11:48:27 AM

Document Has Been Signed on 08/25/2021 11:48 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:CABILLO, MARINELLE C.FACILITY NUMBER:
384004301
ADMINISTRATOR:CABILLO,MARINELLE C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 602-6158
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
08/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Marinelle CabilloTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Andrea Medlin met with Licensee for this required annual visit. Purpose of visit explained. There are 10 children in care; 2 infants and 8 preschool aged. Days and hours of operation: Monday-Friday 8;00AM-5:00PM. Licensee states she and partner are the only ones who reside in the home; criminal record clearance is on file for all adults. Physical plant toured to inspect for health and safety hazards in the licensed areas as well as verifying all areas in the home to ensure facility sketch on file is still current. The areas used for the daycare are: living room, bedroom converted into a daycare room (used for children napping), dining room converted into a daycare play room, portion of the kitchen for meals and snacks, one bathroom for children's use in the rear of home, and outside back play area. Off limits areas are one bedroom (licensee and partner's room) and bathroom next to bedroom. The daycare has a fully charged fire extinguisher that meets the minimum requirements, smoke detectors, and carbon monoxide (CO) detectors located throughout the home. First aid supplies are available. Detergents, cleaning compounds, medications, and other items which could pose a danger to children is stored inaccessible to children. The daycare areas are kept clean and orderly and has adequate heating and ventilation for safety and comfort. Per Licensee, there are no pets and no firearms and weapons in the home. No spas, swimming pools, hot tubs, fish ponds, or similar or bodies of water are present. Variety of age appropriate toys and materials is observed in the daycare. A sick child would be separated from the group and wait for parent to pick up. Staff and children's files reviewed. In the children's files reviewed, all have Parent's Rights (LIC 995A) form, Identification and Emergency Information (LIC 700), and verification of current immunizations. Licensee and staff files reviewed indicate verification of current mandated child abuse reporter (AB1207) training; verification of current Pediatric First Aid and CPR certification; Licensee and staff have the required staff immunizations: measels (MMR) and pertussis (Tdap) on file. The license is posted in the home.

(continued on next page 809-C)
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
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 2
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: CABILLO, MARINELLE C.
FACILITY NUMBER: 384004301
VISIT DATE: 08/25/2021
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Licensee has provided a list of children's names and schedules that attend the daycare which only shows names and days/hours in attendance. Licensee has a child care roster but it is in several pages due to some children have been here longer, others have left, etc.

Licensee will send a current child care facility roster (of only current children attending/enrolled) with all sections of form completed to the licensing office by September 6, 2021.

This report is reviewed with Licensee and a copy of this report must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
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