434400174-9-14-2022-07-CC-MMOO-CJA248-20220914170331

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400174
Report Date: 09/14/2022
Date Signed: 09/14/2022 05:03:37 PM

Document Has Been Signed on 09/14/2022 05:03 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 - COLLINS		FACILITY NUMBER:	434400174
ADMINISTRATOR:	SMITH, SHARON		FACILITY TYPE:	840
ADDRESS:	10300 N. BLANEY AVENUE		TELEPHONE:	(408) 446-5428
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	92	CENSUS: 18	DATE:	09/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:11 PM
MET WITH:	Isabel Perez & Mary Vo		TIME COMPLETED:	05:15 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) Marilou Monico conducted an unannounced Required - 1 Year Inspection. LPA met with Interim Designee of Responsibility (DOR), Mary Vo, and Assistant Site Supervisor, Isabel Perez. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. This facility has no active waivers. The center's operating hours are Monday through Friday 07:00 AM - 8:30 AM and 2:40 PM to 6:00 PM except Tuesdays 2:10 PM to 6 PM. The facility serves children from kindergarten to 15 years old in the two portables and Room 33. LPA toured the facility both indoor and outdoor. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Floors were clean. LPA observed that one of the portables has a bathroom (1 toilet and 1 sink) available for the children. Staff bathroom is located in the other portable. There is a bathroom available for the children located in the elementary school building near the playground. Foods and beverages were kept protected against contamination and spoilage. Drinking water is available for the children indoor via individual water bottles. Trash cans for solid waste had tight-fitting covers on, and were in good repair. Fire extinguisher, functioning carbon monoxide detector and smoke detector were observed. Mary stated that there are no firearms in the facility. Drinking water is readily available for the children outdoor via individual water bottles. The school age program utilizes the elementary school playground after elementary school hours. There were climbing structures in the playground with tanbarks as resilient material underneath and around the structures. There were no bodies of water observed. Continuation on next page:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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 - COLLINS	FACILITY NUMBER: 434400174
	VISIT DATE: 09/14/2022

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
26
27
28
29
30
31
32

LPA reviewed seven (10) children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment, Parent's Rights Receipt, Personal Rights Receipt, Health History, and Immunization. LPA obtained copy of children's roster.

Two (2) staff files were reviewed. LPA reminded Mary that the online AB1207 Mandated Reported Training needs to be renewed every two years. Mary has current certification in Pediatric CPR and First Aid.

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

Mary 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.

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/process.

As a result of this inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with the Interim DOR, Mary Vo.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2