430709735-1-9-2024-07-CC-LFII-CZBS6W-20240109123636

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430709735
Report Date: 01/09/2024
Date Signed: 01/09/2024 12:37:33 PM

Document Has Been Signed on 01/09/2024 12:37 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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CATALYST KIDS - GRAYSTONE		FACILITY NUMBER:	430709735
ADMINISTRATOR:	KRISTINA SMITH		FACILITY TYPE:	840
ADDRESS:	6982 SHEARWATER DRIVE		TELEPHONE:	(408) 997-1980
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95120
CAPACITY:	105	CENSUS: 33	DATE:	01/09/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Afton Scholes		TIME COMPLETED:	12:50 PM

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On 1/9/29024, at 9:40AM, Licensing Program Analyst (LPA) Doni Fici and Licensing Program Manager (LPM) Gladys Kuizon arrived unannounced to conduct a Required 3-Year Inspection and was greeted by Afton Scholes, On-site lead. LPA toured the indoor and outdoor areas of the Facility with On site lead during today's inspection.

LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. Days and hours of operation are Monday through Friday 7:00AM to 6:00PM.

LPA reviewed five (5) children's and three (3) staff files during today's inspection. Each child's file reviewed contains all required forms/documents, including Admission Agreement, Emergency Medical Consent (LIC 627), and Information and Emergency Information form (LIC 700). All staff files reviewed contain the required forms/documents, including current CPR and First Aid certifications on file. On-site lead understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during any off-site activities. Last fire/disaster drill was completed on 11/13/2023.

LPA observed two (2) Staff and zero (0) Children during today's inspection. On-site lead understands the conditions, limitations, and capacity specifications of the Facility license. He understands that children shall be always visually supervised. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted into care. Any child(ren) who become ill during the day, shall be isolated in an isolation area located in the office.

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) -56-5850
LICENSING EVALUATOR NAME: Liridon Fici	TELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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

FACILITY NAME: CATALYST KIDS - GRAYSTONE	FACILITY NUMBER: 430709735
	VISIT DATE: 01/09/2024

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LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. On-site lead understands that the facility must be kept free of flies and other insects & rodents. LPA observed that furniture and equipment is in good condition and safe for the children. Children have their own water bottles labeled with their name on it when playing outdoors. There are water cooler stations for the children along with their water bottles.

LPA observed there is hot and cold running water, refrigerator and microwave on the premises. AM/PM snacks are provided from the facility. The Facility has trash cans with tight fitting lids for solid waste in the classroom. Cleaning supplies are inaccessible to the children and stored in cabinets located in areas off limits to children. LPA observed a complete first aid kit available in the facility.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade rest areas are provided by trees, a canape, and solar panels. There are sufficient resilient materials on the outdoor playground area. LPA did not observe any bodies of water. On-site lead stated that the facility does not provide transportation for school aged children.

On-site 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.

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) -56-5850
LICENSING EVALUATOR NAME: Liridon Fici	TELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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

FACILITY NAME: CATALYST KIDS - GRAYSTONE	FACILITY NUMBER: 430709735
	VISIT DATE: 01/09/2024

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This facility does provide Incidental Medical Services (IMS) at this time. 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

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.

For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

On-site lead understands that children's personal rights should not be violated, including no unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature.

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/inspection-process

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) -56-5850
LICENSING EVALUATOR NAME: Liridon Fici	TELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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

FACILITY NAME: CATALYST KIDS - GRAYSTONE	FACILITY NUMBER: 430709735
	VISIT DATE: 01/09/2024

NARRATIVE

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LPA provided On-site lead with website resources on managing food allergies at school and handling medical emergencies related to food allergies.

CDC Managing Food Allergies at School

https://www.cdc.gov/healthyschools/foodallergies/index.htm

American Academy of Pediatrics Healthy Children Medical Emergencies

https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/When-to-Call-Emergency-Medical-Services-EMS.aspx

A Notice of Site Visit was given and must remain posted for 30 days.

No Deficiencies were issued at this time.

Exit interview conducted with On-site lead, and a copy of this report review and provided.

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) -56-5850
LICENSING EVALUATOR NAME: Liridon Fici	TELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

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