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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400006
Report Date: 08/15/2024
Date Signed: 08/15/2024 10:19:40 AM

Document Has Been Signed on 08/15/2024 10:19 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CATALYST KIDS - BISHOPFACILITY NUMBER:
434400006
ADMINISTRATOR/
DIRECTOR:		RUMA CHOKSHIFACILITY TYPE:
840
ADDRESS:450 NORTH SUNNYVALE AVETELEPHONE:
(408) 739-2611
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY: 105TOTAL ENROLLED CHILDREN: 68CENSUS: 23DATE:
08/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:20 AM
MET WITH:Ruma ChokshiTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Mel Matos met with Ruma Chokshi, Director, for an unannounced case management investigation in response to a self reported Unusual Incident. The Facility contacted the Department via telephone on July 30, 2024 and submitted the written Unusual Incident to the Department on August 5, 2024.

The Unusual Incident occurred on July 29, 2024 at approximately 9:30 AM in the elementary school playground. Note: The Facility is located on the back section of Bishop Elementary School (facing Hazelton Ave) in Building H. Director states that there were 30 school age children and three teachers in the elementary school playground at the time of the incident.

Director states that the group of 30 school age children were playing in the playground area, located approximately 20 feet from one of the entry/exit gates of the playground. Director states that one child briefly stepped outside the entry/exit gate of the playground to look at a tree stump, located directly outside of the entry/exit gate area. Director states that the child was in the line of sight of one of the teachers and was never unsupervised during the incident.

Director states that the entry/exit gates of the playground are locked from 8 AM to 4 PM when the elementary school is in session, but states that the elementary school is currently on summer break until August 18, 2024 and thus the entry/exit gates are not locked during school breaks.

Director states that she spoke with the child's parent at pick up time on July 29, 2024 and also reminded all children that they must stay on campus at all times during school hours. Director states that staff were reminded of supervision protocol while outside in the elementary playground area; especially during school breaks when the entry/exit gates are not locked.

Based on interviews, record reviews, and evidence gathered during the investigation process, it is concluded that although the incident (absence of supervision) may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

Exit interview conducted and report was reviewed with the Director, Ruma Chokshi. No deficiencies issued. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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