434400227-3-15-2022-07-CC-SYIP-CCJR8Y-20220315124845

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400227
Report Date: 03/15/2022
Date Signed: 03/15/2022 12:48:49 PM

Document Has Been Signed on 03/15/2022 12:48 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 - NORDSTROM		FACILITY NUMBER:	434400227
ADMINISTRATOR:	LORENA DOMINQUEZ		FACILITY TYPE:	850
ADDRESS:	1425 E. DUNNE AVENUE		TELEPHONE:	(408) 778-2821
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	24	CENSUS: 7	DATE:	03/15/2022
TYPE OF VISIT:	Required - 1 Year	ANNOUNCED	TIME BEGAN:	10:21 AM
MET WITH:	Lorena Dominquez		TIME COMPLETED:	12:55 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) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Site Director Lorena Dominquez and explained the reason for the inspection. Upon arrival, there were two staff and 7 children. Facility is located on the Nordstrom Elementary School campus. The preschool program only uses Room 1. There is a board to post required postings, such as license, notification of parents, and car seat law. There is working phone. The hours of operation are Monday through Friday 8AM to 11AM. Facility uses an electronic sign in/out. LPA verified that all children were signed in and out during inspection. LPA toured in the inside and outside of the facility. Facility was observed to be clean and floors were free of tripping hazard. Cleaning supplies, disinfectant, and other items that could pose a risk to children were observed to inaccessible. There is sufficient amount of toys for children. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Director stated that there are no weapons, such as firearms, stored on the premise. The outdoor area is fenced. Areas around play structure has tan bark. Shaded rest area is provided through the tree. There were no bodies of water observed during today's inspection. ---------------------------continuation 809 dated 03/15/2022 page 2-----------------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

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 - NORDSTROM	FACILITY NUMBER: 434400227
	VISIT DATE: 03/15/2022

NARRATIVE

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---------------------continuation of 809 dated 03/15/2022 page 1----------------------------------

Facility does provide snacks to children. Kitchen to prepare and store snacks was observed to be clean. Menu was observed to be posted. Drinking water is provided through individual water bottles.

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

A copy of the facility roster was obtained during today's inspection. 7 children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and notification of parent's rights. C-1 enrolled on 03/10/2022 and has an appointment to complete physician's report. Director stated that she will submit a copy to licensing once obtained. LPA also discussed with Director about double checking all forms are filled out correctly.

2 staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit, Health Screening, and Mandated Reporter training. LPA reminded Site Director that Mandated Reporter training requires renewal every 2 years and to check date on certificate. Both staff have a valid CPR/1st Aid. Site Director's CPR/1st Aid expires on 07/23/2022.

------------------------continues on 809 dated 03/15/2022 page 3---------------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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 - NORDSTROM	FACILITY NUMBER: 434400227
	VISIT DATE: 03/15/2022

NARRATIVE

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------------------continuation of 809 dated 03/15/2022 page 2---------------------------------

All staff present had cleared criminal record clearance. Site 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.

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

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

LIC809 (FAS) - (06/04)

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