393607697-4-12-2022-53-CC-SWIS-CDESY2-20220412141648

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393607697
Report Date: 04/12/2022
Date Signed: 04/12/2022 02:16:59 PM

Document Has Been Signed on 04/12/2022 02:16 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	CATALYST KIDS - SOUTH SCHOOL		FACILITY NUMBER:	393607697
ADMINISTRATOR:	RHOADES, MARTI		FACILITY TYPE:	840
ADDRESS:	500 WEST MOUNT DIABLO		TELEPHONE:	(209) 834-1725
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	70	CENSUS: 0	DATE:	04/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Joesefina Jiminez		TIME COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On April 12, 2022, Licensing Program Analyst (LPA) Stacey Williams met with Facility Representative for the purpose of an unannounced required 1 Year annual inspection. The facility is located in portables (Rm #1 and Rm #2) on the campus of South Park Elementary School. Program hours are Monday through Friday 6:30AM-6:30PM. Upon arrival, there were no children present in the facility. Two staff were on site in the facility. Criminal record clearances have been verified. LPA conducted a health and safety inspection for all areas accessible to children. Staff stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. LPA observed a functional smoke/carbon monoxide detector and a fully charged 2A :10BC fire extinguisher. The floors appeared clean throughout the facility. Outdoor play area is free from dangerous conditions and playground equipment is securely anchored to the ground. Facility has bark under the play equipment to absorb falls. Program provides a morning and afternoon snack. The facility operates during school breaks and provides breakfast, lunch, and afternoon snack during this time. Menus were posted on the refrigerator of the facility as well at the the front entry of the facility. Facility offers drinking water by utilizing a water dispenser where each child’s individual cup is filled. Sign in/out sheet are done electronically. Ten child files were reviewed. Each child’s file contained an emergency card, and a medical assessment. Files for staff who were present at the facility were reviewed. Staff have a criminal record clearance, health screening report, immunization records, and documentation of their educational background, training, and/or experience. Mandated reporter training and CPR/First Aid certification was current for files that were reviewed. LPA reviewed the Department's inspection authority and discussed with staff any changes that may occur regarding Director/Site Supervisor or an employee acting in the director's absence must be reported to department within 10 working days. Report continues on 809-C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CATALYST KIDS - SOUTH SCHOOL	FACILITY NUMBER: 393607697
	VISIT DATE: 04/12/2022

NARRATIVE

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Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Per facility representative there are no children that require medication. Facility has an Incidental Medial Service Plan on file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

There were no deficiencies observed during today’s inspection.

Exit interview conducted and report was reviewed with the Facility Representative, Josefina Jimenez. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

LIC809 (FAS) - (06/04)

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