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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710463
Report Date: 10/25/2024
Date Signed: 10/25/2024 10:18:39 AM


Document Has Been Signed on 10/25/2024 10:18 AM - 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 - WILLIAMSFACILITY NUMBER:
430710463
ADMINISTRATOR:WHITNEY LUKANCFACILITY TYPE:
840
ADDRESS:1150 RAJKOVICH WAYTELEPHONE:
(408) 997-8703
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:70CENSUS: 0DATE:
10/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Kathy AbadyTIME COMPLETED:
10:30 AM
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Licensing Program Analysts (LPAs) Mel Matos and Andy Yang met with Kathy Abady, Regional Director, for a case management inspection in response to an Unusual Incident that the Facility self reported to the Department on October 14, 2024.

The Unusual Incident was reported to the Facility on Friday October 11, 2024 by a family of an enrolled school age child. Kathy states that the family was concerned about a staff person and the way the staff person was dressed & acting at the Facility. Kathy states that the staff person was put on leave and the concerns were investigated by the Facility.

Kathy states that the Facility investigation concluded that the staff was in violation of the employer dress code on October 11, 2024; however, there was no evidence of any inappropriate conduct by the staff.

It is therefore concluded that there was no violation(s) as a result of the incident that occurred on October 11, 2024.

Exit interview conducted and report was reviewed with the Program Director, Kathy Abady. No deficiencies issued. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2024
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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