430709506-4-18-2023-07-CC-SYIP-CQZURF-20230418154842

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430709506
Report Date: 04/18/2023
Date Signed: 04/18/2023 03:48:45 PM

Document Has Been Signed on 04/18/2023 03:48 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 - NORDSTROM		FACILITY NUMBER:	430709506
ADMINISTRATOR:	LORENA DOMINGUEZ		FACILITY TYPE:	840
ADDRESS:	1425 EAST DUNNE		TELEPHONE:	(408) 778-2821
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	66	CENSUS: 25	DATE:	04/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Lorena Dominguez		TIME COMPLETED:	03:55 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	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with staff, Alicia Hernandez. Site Director Lorena Dominguez, arrived shortly after. LPA explained the reason for the inspection. Upon arrival, there were two staff and no children present. 25 school-age children arrived shortly after. There is an area to post required postings, such as license, notification of parent's rights, and menu. The hours of operation are Monday, Tuesday, Thursday, and Friday from 2:40PM to 6PM and Wednesdays from 12:40PM to 6PM. LPA reviewed electronic sign in/sign out. LPA toured the inside and outside of the facility. Disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible. Facility was observed to be clean and sanitary. There are toys and equipment for children. Bathroom for children provided individual privacy. There is fully charged fire extinguisher, smoke detector, and carbon monoxide. The last fire/disaster drill was conducted on 03/31/2023. Site Director stated there are no weapons, such as firearms, stored at the facility. The center uses the outside area in front of the portables and the playgrounds on campus. Outdoor area is fenced. There is resilient material around play structure. LPA observed that resilient material is starting to get low. LPA discussed with Site Director about ensuring that there is enough resilient material. There were no bodies of water observed during today's inspection. Shaded rest area is provided through tree and building overhang. -----------------continues on 809 dated 04/18/2023 page 2-------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CATALYST KIDS - NORDSTROM	FACILITY NUMBER: 430709506
	VISIT DATE: 04/18/2023

NARRATIVE

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----------------continuation of 809 dated 04/18/2023 page 1---------------------

Facility does provide snacks to children. Menu was observed to be posted. There is a kitchen to store and prepare food. Drinking water inside is provided through water pitchers and cups and outside through water fountains. Trash can for waste have a tight-fitted lid.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see PIN 22-02-CCP. 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

A copy of the facility roster was obtained. Five (5) children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and consent for emergency medical treatment.

Three (3) staff files were reviewed during today's inspection. The records reviewed include education credit and Mandated Reporter training. All staff have valid CPR/1st Aid. Site Director's CPR/1st Aid expires on 02/09/2025.

All staff present have cleared fingerprints. Site Supervisor 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.

Facility will submit the following:
-paperwork for staff who is a fully qualified director

As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with Site Director Lorena Dominguez. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

LIC809 (FAS) - (06/04)

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