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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004710
Report Date: 08/18/2021
Date Signed: 08/18/2021 02:16:01 PM

Document Has Been Signed on 08/18/2021 02:16 PM - 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:MARCUS, ESTHERFACILITY NUMBER:
414004710
ADMINISTRATOR:MARCUS, ESTHERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 483-8350
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
08/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Licensee, Esther Marcus TIME COMPLETED:
02:30 PM
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On 8/18/2021 at 12:50P.M. Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Esther Marcus. Purpose of the inspection was explained and was for an unannounced Annual/Random inspection. Present was the licensee, licensee’s husband and three children. Per licensee, school age children and minors are her own children. Per licensee, the day-care is permanently closed. Forfeiture letter was submitted by license during inspection. Licensee home is three bedroom, two bathroom, two level house.
Day-care Area: Bottom Level: Playroom, Bathroom #1, Side Yard and Backyard Off-limit Area: Bottom Level: Living Room, Dining Area, Kitchen and Bedroom #1. Upper Level: Bedroom #2, Bedroom #3 and Bathroom #2. Day-care areas were inspected with the licensee for health and safety hazards.

At 1:00P.M., LPA observed the following: Day-care had age- appropriate toys and outdoor playthings. Furniture and playthings inspected were in good repair. All furniture had been securely anchored. LPA observed tables and chairs for snack and activities. Facility was the proper temperature with adequate ventilation and natural lighting. Accessible outlets and trash bins had been covered. Outdoor area was completely enclosed. There were no accessible pools, fishponds or bodies of water. Detergents, cleaning compounds, medications and other items which could pose a danger were being stored inaccessible to children. LPA reminded licensee to document required emergency disaster drills every six months. LPA reminded Licensee to updated CPR/ 1st aid certification. Licensee stated there are no guns or weapons in the home. During inspection LPA reviewed: Resumption of Annual inspections PIN, Request for Inactive form (LIC 9221), Safe Sleep Guidelines and COVID-19 Guidelines. (Continuation on the second page)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
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: MARCUS, ESTHER
FACILITY NUMBER: 414004710
VISIT DATE: 08/18/2021
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(continuation from first page)
Based on today's inspection, no deficiency was observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview and the plan of correction was discussed with Licensee, Esther Marcus, and her signature of this form acknowledges receipt of these documents.

>This report and rights to comment and appeal were discussed with licensee. This report must be available in the facility for public review. Notice of site inspection was posted. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
LIC809 (FAS) - (06/04)
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