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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213005559
Report Date: 06/06/2025
Date Signed: 06/06/2025 11:53:26 AM

Document Has Been Signed on 06/06/2025 11:53 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ST. RAPHAEL - PRESCHOOLFACILITY NUMBER:
213005559
ADMINISTRATOR/
DIRECTOR:		EDITH YATES. *INTERIM*FACILITY TYPE:
850
ADDRESS:1100 FIFTH AVENUETELEPHONE:
(415) 456-1702
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 0DATE:
06/06/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:18 AM
MET WITH:Edith Yates & Melissa MoralesTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On June 6, 2025, Licensing Program Analysts (LPAs) Naves and Van met with Director Edith Yates and Melissa Morales, Administrative Assistant, for a case management inspection to address the capacity increase. During todays visit no children were present the last day of school was the day before June 5, 2025. The department received an application from the facility requesting an increase in capacity for 13 children. Currently, the facility is licensed for 45 preschool-age children and is requesting an increase in capacity to 58.

LPAs, the Director, and the Administrative Assistant inspected both inside and outside the facility, as well as the new classroom, St. Teresa, for health and safety hazards. The St Teresa room was observed to be clean and in good repair, with sufficient lighting and ventilation. A counter for storage and a sink were observed in good condition. The room measures 486.2 sq ft, which accommodates an additional 13 children.

During the visit, the Director informed LPAs that the new classroom will potentially be shared with the K-8 school-age program. LPAs informed the Director that she will need to request a waiver, which includes a schedule for when the school-age program will be using the classroom. LPA also informed the Director that under no circumstances can the two programs comingle at any time.

Currently, the facility has three sinks and three toilets for the preschool program. . However, with the addition of 13 more children to the license, the center will utilize the

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2025
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: ST. RAPHAEL - PRESCHOOL
FACILITY NUMBER: 213005559
VISIT DATE: 06/06/2025
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two extra sinks and toilets in the gym. Since these two sets are also used by the school-age program, the center will have to request a waiver for exclusive use.

Additionally, the center requested an expansion of one of its outdoor spaces, designated as Outdoor #1, which currently accommodates no more than 13 children at a time. To create more room for children, the center planned to remove a large flower planter box. During the visit, the outdoor space was remeasured to include the planter space, and based on the new measurements, it was calculated that the outdoor area is 1084.58 square feet, allowing for 14 children.

The facility is recommended for a capacity increase to 58 once all waivers and additional visits or photos are received, following the removal of the flower bed and the establishment of the new area.

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

Exit interview conducted and report was reviewed with the licensee Director Edith Yates.

This report will be kept in the facility file and made available for public review upon request. Desk Duty is available from Monday-Friday 8:00am-5:00pm. (650)266-8800.Website for forms and regulations: www.cdss.ca.gov.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jaclyn Naves
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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