430710215-3-14-2023-07-CC-HKAR-CPWSVJ-20230314141251

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710215
Report Date: 03/14/2023
Date Signed: 03/14/2023 02:13:19 PM

Document Has Been Signed on 03/14/2023 02:13 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CATALYST KIDS - CUMBERLAND		FACILITY NUMBER:	430710215
ADMINISTRATOR:	LIPP, CINDY		FACILITY TYPE:	840
ADDRESS:	824 CUMBERLAND DRIVE		TELEPHONE:	(408) 736-0179
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	140	CENSUS: 0	DATE:	03/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Cindy Lipp		TIME COMPLETED:	02:45 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 03/14/23 at 9:15 AM., Licensing Program Analyst, Kaur met with school Director Cindy Lipp. Purpose of the inspection was explained and is for an Unannounced Annual/ Random inspection. Facility operates a school age program. Present during inspection was the Director and 1 staff and no children. All staff have their criminal record clearances of file. Hours of operation are Monday- Friday 7:00 am- 6 pm. Program operates year around. LPA inspected facility, indoors and outdoors, with director for health and safety hazards. There is an area to post required postings, such as license and notification of parent's rights. There is working phone on the premise. LPA reviewed electronic sign in/sign out. LPA toured the inside and outside of the facility. Facility was observed to be clean. Disinfectant, cleaning supplies, and other items that are dangerous to children were observed to be inaccessible to children. There are toys for children. All equipment were age-appropriate. Bathroom for children allow for individual privacy and is separated by genders. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Director stated that there are no weapons, such as firearms, stored on the premise. Furniture was in good repair. Toy were free of sharp objects, edges or splinters. Each classroom had several child size tables and chairs for snack and actives. Bathrooms were maintained in safe and sanitary condition. Facility provides meals and snacks for children. There is a kitchen to prepare and store meals and snacks. Menu was observed to be posted. Drinking water is provided through pitchers and cups. Trash can for waste have tight-fitted lids. Last fire drill was conducted on March 7 2023.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Harsimran Kaur	TELEPHONE: (408) 529-3696
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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

FACILITY NAME: CATALYST KIDS - CUMBERLAND	FACILITY NUMBER: 430710215
	VISIT DATE: 03/14/2023

NARRATIVE

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Facility currently does not provide Incidental Medical Services (IMS). For IMS information, see PIN 22-02-CCP. A 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

Five 10 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. Facility has 2 rabbits and chinchilla.

LPA reviewed 5 staff files during today's inspection. The records reviewed include but not limited to Mandated Reporter training, health screening, and education credits. Staff have a valid CPR/1st Aid.CPR/1st Aid expires on 08/12/2024.

All staff present have cleared fingerprints. Director 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.

No deficiencies were cited as a result of this inspection. Exit interview conducted and report was reviewed with Director. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Harsimran Kaur	TELEPHONE: (408) 529-3696
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC809 (FAS) - (06/04)

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