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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004936
Report Date: 10/29/2024
Date Signed: 10/29/2024 02:24:06 PM

Document Has Been Signed on 10/29/2024 02:24 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:CATHER, CAROLEFACILITY NUMBER:
384004936
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 0DATE:
10/29/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Applicant, Carole CatherTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On 10/29/2024, at approximately 12:30PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an announced prelicensing visit at the address listed above. LPA met with Applicant Carole Cather and explained the purpose of the visit. Applicant is seeking a change of location from facility #384004754. Applicant plans to enroll children ages 18 months and up.

Daycare Areas: Living Room, Bedroom #1, Bathroom #1, Bedroom #2, Dining Room, Living Space, and Backyard.
Off-limits Areas: Laundry Room, Kitchen, Bathroom #2, and Bedroom #3.

LPA and Applicant inspected the home for any health or safety hazards. There are fire alarms present in the home. There are fully charged fire extinguishers that are size 2A10BC or larger present. Applicant demonstrated a carbon monoxide detector to be operational during the visit. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. There are temperature and ventilation controls for the comfort and safety of children in care. There is a fireplace present in the Living Room that has been blocked by a bookshelf.

LPA observed age-appropriate toys and learning materials to be present. Furniture was observed to be age-appropriate and free of rough or sharp edges. LPA observed cots and mats to be present. Children will bring bedding from home and take it back once a week for cleaning. Applicant stated that they will provide morning and afternoon snacks. Children will bring water bottles and lunch from home. Safe sleep regulations were discussed. Infant sleeping logs are to be kept for all infants (0 to 2 years). LPA advised that outlet covers shall be installed for all outlets in daycare areas. Window stoppers are to be added for windows in daycare areas. Per Applicant, the Laundry Room shall be rendered inaccessible with a childproof strap.


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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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: CATHER, CAROLE
FACILITY NUMBER: 384004936
VISIT DATE: 10/29/2024
NARRATIVE
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LPA inspected the Backyard and found it to be free of debris and other loose articles. The Backyard is enclosed by a fence that is at least four feet high. There are age-appropriate toys and equipment available. LPA observed a piece of the fence in the corner of the Backyard to be broken. LPA advised that the fence should be repaired or blocked to render it inaccessible to children. Applicant stated that they would block that part of the fence.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 12 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 14 children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (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.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.


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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
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: CATHER, CAROLE
FACILITY NUMBER: 384004936
VISIT DATE: 10/29/2024
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LPA discussed the safe sleep regulations with applicant 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 applicant 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.

On this date, 10/29/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/ subscribe and select the Child Care option to receive email communication.

Prior to approval of licensure, the following must be completed and proof sent to LPA via email:
1) Installation of window stoppers in daycare areas
2) Installation of outlet covers (electrical outlets and coaxial outlets)
3) Straps for Bedroom #3 and the Laundry Room
4) Childproof gate installed in the Backyard stairs
5) Side gate installed in the Backyard
6) Broken portion of fence shall be covered or obstructed
Fire clearance must be received prior to approval.
Exit interview conducted and report was reviewed with the applicant, Carole Cather.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC809 (FAS) - (06/04)
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