434400463-9-21-2022-07-CC-MMOO-CJGW3L-20220921165607

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400463
Report Date: 09/21/2022
Date Signed: 09/21/2022 04:56:12 PM

Document Has Been Signed on 09/21/2022 04:56 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 - C.B. EATON		FACILITY NUMBER:	434400463
ADMINISTRATOR:	AGUSTINEZ, MONICA		FACILITY TYPE:	840
ADDRESS:	20220 SUISUN DRIVE		TELEPHONE:	(408) 257-3570
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY: 70	TOTAL ENROLLED CHILDREN: 40	CENSUS: 26	DATE:	09/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:39 PM
MET WITH:	Monica Agustinez		TIME COMPLETED:	05:10 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 met with Program Lead, Monica Agustinez, for an unannounced Required - 1 Year Inspection. LPA explained to Monica the purpose of today's inspection. LPA observed the following posted materials: Facility's License, Notification of Parents’ Rights, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist. This facility has no active waivers. The center's operating hours are Monday through Friday 07:00 AM - 9:00 AM and 3:00 PM to 6:00 PM except Tuesdays 2:30 PM to 6 PM. The facility serves children from kindergarten to 8th grade in Rooms 20 & 21.. The indoor and outdoor areas of the facility were inspected. The teacher-child ratio was in compliance. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Cleaning products and other items that are dangerous to children were stored inaccessible to children. Floors were clean. There is children's bathroom in Room 21 (1 toilet & 1 sink). There is a separate staff bathroom (1 toilet & 1 sink) in Room 20 which an isolated child can use if needed. There are bathrooms (girl's and boy's bathrooms) located in the elementary school building across Rooms 20 & 21 available for the school age children,. Foods and beverages were kept protected against contamination and spoilage. Drinking water is available for the children indoor via individual water bottles. LPA observed trash cans with tight fitting lids for the disposal of solid waste. The facility has fire extinguisher, functioning carbon monoxide detector and working smoke detector. Monica states that there are no firearms in the facility. Drinking water is readily available for the children outdoor via individual water bottles. The school age children utilize the C.B. Eaton Elementary School playground after school hours. The playground has climbing structures with tanbarks as resilient material underneath and around the structures. Shade is provided by trees. There were no bodies of water observed. Continuation on next page:

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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 - C.B. EATON	FACILITY NUMBER: 434400463
	VISIT DATE: 09/21/2022

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LPA reviewed 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, and Health History. LPA obtained copy of children's roster.

Three (3) staff files were reviewed. At least one staff member present during the inspection has current CPR/First Aid certification. LPA reminded Monica that the Mandated Reported Training for Child Care Providers (AB1207) shall be renewed by staff every two years.

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

Monica 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 Program Lead, Monica Agustinez.

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

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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