430710463-4-5-2023-07-CC-JCRZ-CQM3J4-20230405181653

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710463
Report Date: 04/05/2023
Date Signed: 04/05/2023 06:17:09 PM

Document Has Been Signed on 04/05/2023 06:17 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 - WILLIAMS		FACILITY NUMBER:	430710463
ADMINISTRATOR:	WHITNEY LUKANC		FACILITY TYPE:	840
ADDRESS:	1150 RAJKOVICH WAY		TELEPHONE:	(408) 997-8703
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95120
CAPACITY:	70	CENSUS: 25	DATE:	04/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:02 PM
MET WITH:	Ninveh Khoshabian		TIME COMPLETED:	05:30 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) Janette Cruz met with Ninveh Khoshabian, Center Manager for an unannounced Required- 1 Year inspection. LPA toured the indoor and outdoor areas of the facility during today's inspection. The program operates on an active elementary school campus, Williams Elementary and is licensed to serve a maximum of 70 school age children age range Kindergarten through 13 years in the two (2) portable classrooms (O and Y) only. Days and hours of operation are Monday through Friday 6:30am to 8:55am, and 2:00pm to 6:00pm. Ninveh stated that there is currently no enrollment for the AM school-age program. 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), and Activity Schedule. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Last fire drill was done on 2/16/2023. LPA reviewed five children's files and three staff files (center manager, teacher, 1 teacher substitute) during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and required licensing forms. All staff files reviewed contain the required transcripts/verification of experience, and Health Screening Report. LPA reviewed current certificates of completion of the Mandated Reporter Training for Child Care Workers and current CPR and First Aid certifications for staff on file. Center Manager understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during outdoor activities. LPA observed there is a sign in / out sheet, updated throughout the day, containing full signatures from responsible parties. Director stated that children are observed for illnesses and general well-being upon arrival.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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 - WILLIAMS	FACILITY NUMBER: 430710463
	VISIT DATE: 04/05/2023

NARRATIVE

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LPA observed that the teacher/child ratio was in compliance during today's inspection. Present during the inspection were 25 school age children and three staff. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the facility's office.

LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Center Manager understands that the facility must be kept free of insects & rodents. LPA observed that all furniture and equipment are in good condition and safe for the children. Drinking water is readily available for the children in the facility and in the outdoor playground area via pitchers and water bottles labeled with each child's name. Children's bathrooms are clean, sanitary, and in working order. Staff bathroom is located in school's cafeteria. Center Manager states that there are no weapons or firearms on the premises. LPA observed that the facility is equipped with functional smoke detectors, carbon monoxide detectors, complete First Aid Kits, and Fire Extinguishers.

The food preparation and storage areas are clean, free of litter & rubbish, free of rodents and other vermin. There is also a hot and cold running water, refrigerator and microwave on the premises. Snacks are prepared at the facility or brought from home. Menu was posted. The kitchen used to prepare snacks was observed to be clean and sanitary. The Facility has trash cans with tight fitting lids for solid waste in the classroom. LPA observed cleaning supplies was stored inside cabinet located in one of the children's bathrooms accessible to the children .

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. There is sufficient resilient materials (grass) on the outdoor playground area. LPA did not observe any bodies of water. Center Manager states that the facility does not provide transportation.

Center Manager 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.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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 - WILLIAMS	FACILITY NUMBER: 430710463
	VISIT DATE: 04/05/2023

NARRATIVE

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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 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

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

Exit interview conducted and report was reviewed with Ninveh Khoshabian, Center Manager. Deficiencies were cited during today's inspection.

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

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/05/2023 06:17 PM - It Cannot Be Edited

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 - WILLIAMS	FACILITY NUMBER: 430710463
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101238(g)

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in, disinfectant/cleaning supplies were stored in an unlocked cabinet inside the children's bathroom which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/14/2023
	Plan of Correction
1 2 3 4	Licensee immediately removed the disinfectant supplies from the children's bathroom and stored in locked cabinet under the kitchen sink. Licensee will submit to LPA a plan of correction to ensure that all disinfectants, cleaning solutions and poisons are properly stored and made inaccessible to children at all times.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC809 (FAS) - (06/04)

Page: 10 of 11

Document Has Been Signed on 04/05/2023 06:17 PM - It Cannot Be Edited

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 - WILLIAMS	FACILITY NUMBER: 430710463
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above. S2 did not have proof of updated Mandated Reporter Training certificate upon inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2023
	Plan of Correction
1 2 3 4	Licensee will submit to LPA Cruz by POC due date a proof of enrollment/certificate of S2 for the Mandated Reporter Training.

Type B

Section Cited

CCR

101515(b)

School-Age Child Care Center Director Qualifications and Duties

(b) All school-age child care centers shall have a director. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. There was no qualified director present in the facility during inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2023
	Plan of Correction
1 2 3 4	Licensee will submit an application for a qualified director to LPA by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC809 (FAS) - (06/04)

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