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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422660
Report Date: 06/24/2022
Date Signed: 06/24/2022 12:16:54 PM

Document Has Been Signed on 06/24/2022 12:16 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CATO, SHANNONFACILITY NUMBER:
013422660
ADMINISTRATOR:CATO, SHANNONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 982-9276
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
06/24/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Shannon CatoTIME COMPLETED:
12:30 PM
NARRATIVE
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On June 24, 2022 Licensing Program Analysts (LPAs) Indira Loza and Catherine Fernandes arrived at the facility to conduct a case management visit as a direct result to an Unusual Incident report received in our office. Present for the visit were the Licensee, the Licensee's Assistant, and the Licensee's mother. There were 6 preschool children, 3 infants, and one school-age child.

Based on interviews conducted by our Investigative Bureau, our office has determined that PJ Rivers has been volunteering at the Family Child Care Home without benefit of a Criminal Background Clearance. This is a Type A violation of section 102395(a)(1).

The interviews conducted by our Investigative Department has also led to the conclusion that a child was able to touch another daycare child inappropriately, violating their Personal Rights. Which is also a Type A Violation of section 102423(a). Two Type A deficiencies are being cited during today's inspection. The Licensee must provide a copy of this report to all parents of children currently enrolled, and the parents of newly enrolled children in the next 12 months. In addition, Form LIC 9224 (Acknowledgment of receipt of Licensing Reports) must be signed by each parent and placed in each child's file.

A copy of the LIC 9224 is being provided to the Licensee during the inspection.

Exit Interview conducted with licensee Shannon Cato.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2022
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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Document Has Been Signed on 06/24/2022 12:16 PM - It Cannot Be Edited


Created By: Indira Loza On 06/24/2022 at 11:10 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CATO, SHANNON
FACILITY NUMBER: 013422660

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2022
Section Cited
CCR
102395(a)(1)

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(a) An immediate penalty of $100 per cited violation per day for a maximum of five (5) days shall be assessed for the following:
(1) Failure to obtain a California clearance or criminal record exemption...as specified in Section 102370(d) for any individual required to
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Review the regulation and immediately remove the individual from the day care and get fingerprints.
An immediate civil penalty has been assessed in the amount of $500.

*As of todays inspection the individual is now finger print cleared and associated to
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fingerprinted under Health and Safety Code Section 1596.871 prior to allowing the individual to work, reside or volunteer in the facility. Based on Interviews, it has been determined that an unfingerprinted adult was in the presence of children. This poses an immediate risk to the health and safety of children in care.
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the day care.
Type A
06/27/2022
Section Cited
CCR102423(a)

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(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged These rights include, but are not limited to, the following: . This requirement has not been met as evidenced by:
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Review the cited regulation and watch the video "Supervising children in a Family Child Care Home" then write a statement of what was learned by POC date.
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an incident reported by Licensee on May 9, 2022 there was a lack of supervision which poses an immediate risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2022


LIC809 (FAS) - (06/04)
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