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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005167
Report Date: 11/15/2024
Date Signed: 11/15/2024 12:05:56 PM

Document Has Been Signed on 11/15/2024 12:05 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:REYES, MARISELAFACILITY NUMBER:
414005167
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
11/15/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Marisela ReyesTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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On November 15, 2024, at approximately 11:30 AM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, case management visit. LPA met with the licensee Marisela Reyes and explained the purpose of the visit. Present during LPA's visit included the licensee, and 5 children (3 infants and 2 preschool age).

Licensees requested to increase capacity from a small family child care home to a large family child care home. Capacity increase application was submitted to department October 23, 2024. Fire clearance approval has been obtained on November 5, 2024.

Licensee Marisela Reyes lives in home with two minor children. Licensee was reminded if children live in the home under 10 years old, they are counted towards overall capacity. All adults living and/or working in the home have fingerprint clearance on file. Hours of operation are Monday through Friday 8:00 AM to 5:00 PM and 5:00 PM to 12:00 AM for after hours care.

Day Care Areas: Living room, Enclosed Patio, Bathroom 1, Bedroom 1, and Backyard. Per applicant, she plans to utilize Bedroom #1 as an isolation for sick/ill children.

Off-limit Area: Master Bedroom with Bathroom, Bedroom 2, Kitchen, Dining Room, and Garage.


Home is equipped with a fully charged fire extinguisher, first aid kit and smoke and carbon monoxide detectors. LPA observed a carbon monoxide detector in main day care area(living room), which was in working condition.

Capacity limits and ratios for a large family day care have been reviewed with the licensees on this date. LPA reminded licensees that an assistant must be present when operating as a large license. LPA reminded licensees when an assistant is not present, licensees must operate within capacity limits of a small family child care home.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: REYES, MARISELA
FACILITY NUMBER: 414005167
VISIT DATE: 11/15/2024
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Because the licensee rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

LPA will approve license for a capacity of 14 children, as of today’s date, 11/15/2024.

No deficiencies were issued during today's visit. A notice of site visit was given and must remain posted.

Exit interview conducted and report was reviewed with the licensee Marisela Reyes.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
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