<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410517377
Report Date: 05/31/2024
Date Signed: 05/31/2024 04:41:18 PM

Document Has Been Signed on 05/31/2024 04:41 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:CATALYST KIDS - HENRY FORD (SCHOOL AGE)FACILITY NUMBER:
410517377
ADMINISTRATOR/
DIRECTOR:		BRIANA HUSS/CINDY LIPPFACILITY TYPE:
840
ADDRESS:2498 MASSACHUSETTS AVENUETELEPHONE:
(650) 368-1138
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 70TOTAL ENROLLED CHILDREN: 48CENSUS: 24DATE:
05/31/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Carmen GuzmanTIME VISIT/
INSPECTION COMPLETED:
04:55 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 May 31, 2024, at @ 1:45pm Licensing Program Analyst (LPA) Maria Olguin-Leon met with teacher, Carmen Guzman for an unannounced annual inspection. Purpose of inspection was explained. Present today, Director, 3 staff and 24 school age children. Interim Director Ruma Chokshi arrived at approx. 3:00pm. All adults have criminal background clearances. Facility is operating within capacity and in compliance with staff child ratio. Facility operates morning and after-school program from Monday to Friday 6:30AM to 8:15 AM and 1:45 PM to 6:00PM, Thursday 1:00 PM to 6:00PM.

LPA toured the facility for health and safety hazards. Facility operates in two portable classrooms A (3rd grade and up) & B (TK-2nd grade) on the campus of Henry Ford School. Classrooms are clean with proper ventilation. There are plenty of age-appropriate toys/games, art/crafts material, furniture (sofas and tables) and learning materials all in good repair. Children’s belongings are stored in cubbies located inside classrooms. All trash containers have tight fitting lids. There are two bathrooms located in classroom B, each with one toilet and one sink in working condition. There are locked storage cabinets located in both bathrooms. There is a separate staff bathroom. Facility shares school playground, which is equipped with swing set, large slide/climber play structure and in good condition. Playground flooring is equipped with tanbark to cushion fall. Children use the grass area behind playground and blacktop. There is second playground used for the younger children with a climbing dome, slide/climber/tunnel play structure which is equipped with tanbark to cushions falls. Area is equipped with a blacktop area and surrounded with a 5 ft. chain link fence. No pools or bodies of water were observed.

Morning and after school program provide snacks for children in care. Food is properly stored and labeled in cabinets and refrigerator to avoid contamination. Children bring their own labeled water bottles and water is refilled with Brita water dispenser. There is a fully equipped first aid kit and Incidental Medical Services were discussed.

Cont. on page 2…
Marie RodriguezTELEPHONE: (650) 266-8800
Maria Olguin-LeonTELEPHONE: 650-266-8800
DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 11
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: CATALYST KIDS - HENRY FORD (SCHOOL AGE)
FACILITY NUMBER: 410517377
VISIT DATE: 05/31/2024
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
26
27
28
29
30
31
32
Page 2...

Isolation area for sick children is the office area and away from other children. All cleaning products, chemicals, and toxins are inaccessible to children and locked in storage cabinets. Facility uses electronic sign in/out on Hubbe App. Staff sign in children into after school and parents sign children out using a PIN#. Classrooms are equipped with smoke alarms, carbon monoxide detector and fully charged fire extinguisher. Classrooms are equipped with a sprinkler system. There is landline located at the facility and staff uses walkie talkies to communicate.

LPA reviewed 5 children’s records and 3 staff record, children records were complete and up to date. Facility was missing two staff files. The facility has all necessary paperwork available and posted, which includes Facility License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. Last emergency drill was conducted on 05/02/2024 and properly documented. Per Director there are no firearms or weapons on site. First aid kit is fully equipped with medical supplies.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Director was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

The Director was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Cont. page 3...
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
Page: 2 of 11
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: CATALYST KIDS - HENRY FORD (SCHOOL AGE)
FACILITY NUMBER: 410517377
VISIT DATE: 05/31/2024
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
26
27
28
29
30
31
32
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

LPA reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Director 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 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.

See page 809D for deficiencies cited today, under Title 22 Division 12 of the California Code of Regulations.
A notice of site visit will be emailed and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director Ruma Chokshi. Report will be emailed to rchokshi@catalystkids.org.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
Page: 3 of 11
Document Has Been Signed on 05/31/2024 04:41 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 05/31/2024 at 04:09 PM
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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CATALYST KIDS - HENRY FORD (SCHOOL AGE)
FACILITY NUMBER: 410517377

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview, the licensee did not comply with the section cited above in lead testing has not been completed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
1
2
3
4
Director will follow up Vendor regarding lead testing for after school program and have lead testing completed per directives.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review the licensee did not comply with the section cited above in 3 out of 3 out of staff present did not have CPR/First Aid certification, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
1
2
3
4
Staff will complete CPR/First Aid training in June and will submit proof to LPA by POC deadline
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:Marie Rodriguez
TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME:Maria Olguin-Leon
TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2024


LIC809 (FAS) - (06/04)
Page: 4 of 11
Document Has Been Signed on 05/31/2024 04:41 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 05/31/2024 at 04:09 PM
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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CATALYST KIDS - HENRY FORD (SCHOOL AGE)
FACILITY NUMBER: 410517377

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 staff did not personnel files available for review, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2024
Plan of Correction
1
2
3
4
Director will send LPA copies of files for staff, including transcripts, health screen, immunization records, listed on LIC125.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Marie Rodriguez
TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME:Maria Olguin-Leon
TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2024


LIC809 (FAS) - (06/04)
Page: 5 of 11