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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709714
Report Date: 05/23/2022
Date Signed: 05/25/2022 08:24:00 AM

Document Has Been Signed on 05/25/2022 08:24 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CATALYST KIDS - P.A. WALSHFACILITY NUMBER:
430709714
ADMINISTRATOR:DARIANI, SALVADORFACILITY TYPE:
840
ADDRESS:353 WEST MAIN AVENUETELEPHONE:
(408) 778-2896
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 15DATE:
05/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Dariani SalvadorTIME COMPLETED:
05:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Site Supervisor Dariani "Dari" Salvador and explained the reason for the inspection. Present during today's inspection were 3 staff and 15 children. LPA reminded Director that children need to be supervised at all times, such as going through from one room to the other or going outside.

License and Notification of Parent's Rights were observed to be posted. The hours of operation are Monday through Friday 6:30AM to 6PM. Sign in and sign out was reviewed during today's inspection.

LPA toured the inside and outside of the facility with Site Director. The facility was observed to be clean and floors were free of tripping hazard. Disinfectant, cleaning supplies, and other items were observed to be inaccessible to children. Toys and equipment were observed to be in good condition. There is a fully charged fire extinguisher and smoke detector. Facility has a carbon monoxide detector, but it was not plugged in. Director plugged in carbon monoxide detector during today's inspection. Director stated that there are no weapons, such as firearms, stored in the facility.

The outdoor area is fenced. Area around play structure and swings have tan bark to absorb falls. LPA observed that the tan bark underneath the swing was starting to get low. During today's inspection, Director racked tan bark so it was even under the swing. LPA discussed with Director about ensuring that there is resilient material under any play structure. Shaded Rest area is provided through canopy. There were no bodies of water observed during today's inspection.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2022
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 - P.A. WALSH
FACILITY NUMBER: 430709714
VISIT DATE: 05/23/2022
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All meals and snacks are prepared and brought from the school district. There is a refrigerator and a kitchen area to prepare and store food. Menu was observed to be posted. Drinking water is provided through water pitchers and cups.

This facility provides Incidental Medical Services – IMS. 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. 10 children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement, parent's rights, and personal rights.

3 staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit, Mandated reporter training, and immunization records. The Director has a valid CPR/1st Aid, which expires on 01/28/2023.

2 out of the 3 staff present are associated to the facility roster. S-1 is a sub from Child Care Career. LPA checked Guardians on 05/23/2022 and observed that S-1 has cleared fingerprints. LPA observed TLR 3: Trustline to Community Care Licensing Criminal Background Clearance Transfer Request was submitted. S-1 is associated to Catalyst Kids- C.B. Eaton #434400463. Director submitted LIC 9182 during today's inspection. Site

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
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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 - P.A. WALSH
FACILITY NUMBER: 430709714
VISIT DATE: 05/23/2022
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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, two type B citations and one technical violations were cited. A $100 civil penalty for caregiver background check was assessed. Exit interview conducted and report was reviewed with the Site Director Dariani Salvador. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/25/2022 08:24 AM - It Cannot Be Edited


Created By: Samantha Yip On 05/23/2022 at 04:39 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CATALYST KIDS - P.A. WALSH
FACILITY NUMBER: 430709714

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101170(e)(2)
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: Request a transfer of a criminal record clearance as specified in Section 101170(f) or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 3 person, which poses/posed a potential health, safety or personal rights risk to persons in care. S-1 is associated to Catalyst Kids- C.B. Eaton, but is not associated to this facility number.
POC Due Date: 05/24/2022
Plan of Correction
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Deficiency was corrected during today's inspection. Director transferred fingerprints during today's inspection.
Type B
Section Cited
HSC
1596.954
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Facility has a carbon monoxide detector, but it was not plugged in, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2022
Plan of Correction
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Deficiency was corrected during today's inspection. Director plugged in carbon monoxide detector during today's inspection.
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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022


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