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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709552
Report Date: 05/05/2022
Date Signed: 05/05/2022 12:35:12 PM


Document Has Been Signed on 05/05/2022 12:35 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 - NIMITZFACILITY NUMBER:
430709552
ADMINISTRATOR:FRANCISCO, FRANCZESCAFACILITY TYPE:
840
ADDRESS:545 CHEYENNE DRIVETELEPHONE:
(408) 736-6176
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:86CENSUS: 13DATE:
05/05/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Alyssa Scholes TIME COMPLETED:
12:45 PM
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On 5/5/2022: Licensing Program Analysts (LPA) Pete Hernandez, made a case management inspection in response to an unusual incident that was self-reported to Licensing by Regional Director, Kathy Abady, on 4/26/22. LPA explained the purpose of the visit to the Site Supervisor Alyssa Scholes and interviewed her and a staff involved with the incident. LPA observed 2 Teachers and 13 preschool children. The facility is compliant with staffing to children ratios.

LPA Hernandez conducted an initial interviews with the Licensee and Director. Records were provided reviewed and copies were obtained.

The above unusual incident report NEEDS FURTHER INVESTIGATION. Exit interview was conducted and a copy of this report was provided to the Licensee, Alyssa Scholes.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
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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