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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004936
Report Date: 12/10/2025
Date Signed: 12/10/2025 04:45:29 PM

Document Has Been Signed on 12/10/2025 04:45 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:		CAROLE CATHERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(786) 804-9170
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY: 12TOTAL ENROLLED CHILDREN: 13CENSUS: 11DATE:
12/10/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Licensee, Carole CatherTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On December 10, 2025, at approximately 2:10PM, Licensing Program Analyst (LPA) Nicole Tran conducted an unannounced annual inspection visit. LPA met with licensee, Carole Cather (L1) and explained the purpose of the visit. Present during the visit was L1, two helpers, 3 infants and 8 preschool age children. The facility’s operating hours are Monday to Friday from 8:30AM – 4:30PM.

Daycare Areas: Playroom (Living Room), Nap Room (Bedroom #1), Classroom (Bedroom #2), Bathroom #1, Dining Room, Kitchen (only for passing through), Hallway, Shoe Room (Living Space), and Backyard.
Off Limit Areas: Bedroom #3 and Bathroom #2.

LPA inspected the facility for health and safety hazards with L1. LPA observed all electrical outlets have been secured with covers or made inaccessible by furniture. Poisons, chemicals, and cleaning solutions are stored high on shelves, inaccessible to children in care. There are multiple smoke and carbon monoxide detectors throughout the home. Facility is equipped with two fully charged 2A10BC fire extinguishers and a complete first aid kit. Off-limit areas have been made inaccessible with child safety gates and latches. There is a non-operating fireplace in the Playroom that has been barricaded with furniture. Per L1, there are no firearms or weapons at the facility.

LPA observed the Playroom to have a variety of age-appropriate toys and equipment. There is a carpet and rubber padding to cushion the ground for any falls. Furniture is in good repair and is free of loose, sharp, and rough edges. Hooks are available for children’s coats and personal items in the Shoe Room. Children have access to art supplies, books, manipulatives, and more. Children nap on cots in the Nap Room. Families provide bedding materials and bring them home weekly to wash.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 12/10/2025
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The Dining Room has a sink for children to wash their hands before eating. Per L1, the facility provides morning snack and afternoon snack. Children bring lunch from home and LPA observed their food containers to be appropriately labeled with their names. Currently enrolled children do not have any allergies or medications. Drinking water is readily available from children’s water bottles and refilled from tap or the refrigerator water dispenser as needed.

Children can use Bathoom #1 in the Classroom and LPA observed it to be clean, in working condition, and to have age-appropriate toileting equipment. Accessible cabinets and drawers were free of chemicals and poisonous items. Families provide diapers and wipes and LPA observed them to be individually stored. The facility also has extra wipes if needed.

The Backyard is fully enclosed and fenced. LPA observed age-appropriate toys and equipment present. Balance bicycles, tricycles, and play structures are available for children to play with. There is also artificial turf to cushion falls. Trees and buildings offer ample shade for children to rest and play under. LPA did not observe any swimming pools or other similar bodies of water on the premises.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

LPA reviewed four children’s files and facility records. Children’s records were observed to include their emergency information and immunization records. LPA observed 15-minute sleep logs properly documented for infants under 24 months of age. All required postings were available for review in the Shoe Room. All adults living or working in the home have been associated to the facility and have criminal record clearance. The last emergency drill was conducted in June 2025. L1 has current pediatric CPR/First training expiring in 5/2027 and Mandated Reporter training expiring on 12/28/2025. L1 has current child care liability insurance. Helpers’ files have their immunization records available for review.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
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: 12/10/2025
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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.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was informed of the MyChildCarePlan.org website; 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

No deficiencies were cited during today’s visit on December 10, 2025.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Carole Cather.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
LIC809 (FAS) - (06/04)
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