430709462-12-1-2022-07-CC-MMOO-CLPVTJ-20221201154314

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430709462
Report Date: 12/01/2022
Date Signed: 12/01/2022 03:43:22 PM

Document Has Been Signed on 12/01/2022 03:43 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CATALYST KIDS - GARDEN GATE		FACILITY NUMBER:	430709462
ADMINISTRATOR:	MADHU PAUL		FACILITY TYPE:	840
ADDRESS:	10500 ANN ARBOR AVENUE		TELEPHONE:	(408) 725-0269
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	84	CENSUS: 22	DATE:	12/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Madhu Paul		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA) Marilou Monico met with Program Lead, Madhu Paul, for an unannounced Required - 1 Year Inspection. The purpose of today's inspection was explained to Madhu. LPA observed the following posted materials: Facility's License, Notification of Parents’ Rights, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist. The center's days and hours of operation are Monday through Friday 2:00 PM to 6:00 PM, except for Tuesdays from 1:30 PM to 6:00 PM and during school breaks/holidays from 7:00 AM to 6:00 PM. The facility serves children from kindergarten through 14 years old in Rooms 20 and 21. LPA toured the indoor and outdoor areas of the facility. The school age program is located in the school site of Garden Gate Elementary School. LPA observed that the teacher-child ratio was in compliance. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Cleaning products are stored in a locked cabinet under the sink in the kitchen located in Room 21. There are two bathrooms with one toilet and one sink in each bathroom in Room 21 available for the children. The bathrooms provide individual privacy. There is a separate staff bathroom with one toilet and one sink in Room 21. Sick children will use the staff bathroom if needed. There are bathrooms located at Garden Gate Elementary School available for the school age children if needed. The facility provides afternoon snacks to children. There is a kitchen in Room 21 for food preparation. The kitchen is equipped with stove, oven, microwave, refrigerator, and a sink with hot and cold running water. Foods and beverages were kept protected against contamination and spoilage. Drinking water is available for the children indoor via individual water bottles. LPA observed trash cans with tight fitting lids for the disposal of solid waste. The facility has fire extinguisher, functioning smoke and carbon monoxide detectors. Continuation on next pages:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CATALYST KIDS - GARDEN GATE	FACILITY NUMBER: 430709462
	VISIT DATE: 12/01/2022

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

Program Lead states that there are no weapons or firearms on the premises. Drinking water is readily available for the children outdoor via individual water bottles. The school age children utilized the outdoor play areas located in front of Rooms 20 & 21 and the one located beside Room 21. The playgrounds have climbing structures with tanbarks as resilient material. Shades are provided by trees. There were no bodies of water observed.

Ten (10) children's files were reviewed. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment, Parent's Rights Receipt, Personal Rights Receipt, and Health History. LPA obtained copy of children's roster.

Two (2) staff files were reviewed with the following documents: Criminal Record Statement (LIC 508), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), Employee Rights (LIC 9052), Personnel Record (LIC 501)/Job Application, Health Screening (LIC 503) with TB test, immunization in measles, pertussis, and flu, required education and training. Madhu has current CPR/First Aid certification. LPA reminded Program Lead that the Mandated Reported Training for Child Care Providers (AB1207) shall be renewed by staff every two years.

This facility provides Incidental Medical Services – IMS. Program Lead states that none of the children enrolled currently using any medication. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

Program Lead 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.

Continuation on next page:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CATALYST KIDS - GARDEN GATE	FACILITY NUMBER: 430709462
	VISIT DATE: 12/01/2022

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

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.

As a result of this inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with Madhu Paul, Program Lead.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3