434416392-10-8-2021-07-CC-JCRZ-C7LTZ5-20211008150946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416392
Report Date: 10/08/2021
Date Signed: 10/08/2021 03:10:05 PM

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 - STIPE		FACILITY NUMBER:	434416392
ADMINISTRATOR:	QUY NGUYEN		FACILITY TYPE:	850
ADDRESS:	5000 LYNG DRIVE		TELEPHONE:	(408) 412-5486
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	42	CENSUS: 9	DATE:	10/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Lorena Dominguez		TIME COMPLETED:	03:40 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 Analysts (LPA) Janette Cruz met with Lorena Dominguez, Center Manager, for an unannounced Required - 1 year inspection. LPA toured the Facility (indoor and outdoor areas) during today's inspection. LPA notes that the Facility is licensed in the following rooms: 152A and 152B for children ages 2 to entry to Kindergarten. 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), Menus, and Activity Schedule. The facility has no active waivers on file. LPA reviewed nine children's and two staff files (2 teachers) during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). Some children's files reviewed do not have complete medical assessment (i.e Physician's Report and Immunization Records). Electronic Sign in and sign out sheets were reviewed and were in compliance, including legal signatures. All staff files reviewed contain the required transcripts/verification of experience/immunization records (including flu vaccine opt out forms) and Health Screening Report (LIC 501). All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. LPA reviewed that all staff present have current CPR and First Aid certifications 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 off-site activities (field trips). LPA observed that the teacher/child ratio was in compliance during today's inspection. Center Manager understands the conditions, limitations, and capacity specifications of the Facility license. Center Manager 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 office area at Room 152A. Center Manager states that the Facility has adequate cleaning/sanitizing supplies & PPE equipment. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

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 - STIPE	FACILITY NUMBER: 434416392
	VISIT DATE: 10/08/2021

NARRATIVE

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LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Center Manager states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Center Manager understands that the Facility must be kept free of flies and other 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 water bottles prepared for each child. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom which an isolated child can use if needed. Center Manager states that there are no weapons or firearms on the premises. The Facility has working smoke and carbon monoxide detectors.

LPA observed that the food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored in locked cabinets/high shelves inaccessible to children. Center manager states that there are no poisons in the Facility. Center Manager states that the Facility does not administer medication at this time.

LPA observed the playgrounds is age-appropriate and surrounded by appropriate fencing. There is no play structure in the playground. There is shade in the outdoor space available for rest area. LPA did not observe any bodies of water during today's inspection. Transportation will not be provided by this facility.

Licensing Forms, Title 22 Regulations and information can be obtained through the internet at www.cdss.ca.gov.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

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 - STIPE	FACILITY NUMBER: 434416392
	VISIT DATE: 10/08/2021

NARRATIVE

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A review of staff records on 10/08/21 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions but not associated to the facility. LPA reminded Center Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.

LPA conducted an exit interview with the Center Manager prior to the conclusion of today's inspection and advised her that Type B deficiencies are issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED AND POSTED NEAR THE ENTRANCE TO THE FACILITY, 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: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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 - STIPE	FACILITY NUMBER: 434416392
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/08/2021 Section Cited	1 2 3 4 5 6 7	102370 (d)(2) Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (2)Request a transfer of a criminal record clearance as specified in Section 102370(j). This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on observation, interviews and record reviews, three of the staff present in the facility: Lorena Dominguez, Alena Pantoja and Monica Salinas were not associated to Catalyst Stipe location.	8 9 10 11 12 13 14	Civil penalty of $100 x 3 staff assessed today (see LIC 421BG).
Type B 10/29/2021 Section Cited	1 2 3 4 5 6 7	10221(d)(1)(G)(H)Child's RecordsAll children's records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours. (G) Immunization records as specified in Section 101220.1(g). (H) Any other records containing current emergency or health-related information for current children in care.
	8 9 10 11 12 13 14	Based on observation, interviews and record reviews, two children did not have immunization records on file : Avery Mendez & Olivia Duffy while 4 children did not have Physician's Report:1.Aline Alvarez, Olivia Duffy, Avery Mendez & Roman Burgess	8 9 10 11 12 13 14

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: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC809 (FAS) - (06/04)

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