434408743-8-8-2023-07-CC-PHEZ-CUHRWL-20230808132320

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408743
Report Date: 08/08/2023
Date Signed: 08/08/2023 01:23:45 PM

Document Has Been Signed on 08/08/2023 01:23 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CATALYST KIDS - TRACE		FACILITY NUMBER:	434408743
ADMINISTRATOR:	IMELDA LLORIN		FACILITY TYPE:	840
ADDRESS:	651 DANA AVENUE		TELEPHONE:	(408) 278-1876
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY: 70	TOTAL ENROLLED CHILDREN: 70	CENSUS: 26	DATE:	08/08/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Imelda Llorin		TIME COMPLETED:	01:31 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) Pete Hernandez conducted a scheduled Case Management - Licensee Initiated inspection with Licensee's Representative, Director Imelda Llorin. LPA explained the purpose of the visit. Licensee Catalyst Kids Trace Elementary School is requesting a change in rooms per the school District's request 651 Dana Ave San Jose CA 95126. Per the School District request, the School-Age Center will be moving from the rooms 51 and room K-2 on a functioning school site of Trace Elementary School at the request of the San Jose Union School District dated 5/16/23. The new rooms are rooms 50, C-9. A Fire Clearance inspection was requested on 8/4/2023 from the San Jose Fire Department. There is a letter from the CUSD Superintendent's Office authorizing the use of the rooms for a total of 96 children at 48 children per room capacity. The Fire extinguishers in the rooms were last serviced on 6/30/2023. LPA also observed that the facility has working carbon monoxide and smoke detectors, and first aid kits. INDOOR MEASUREMENTS ARE AS FOLLOWS: Room #50: (23.5 X 39.5) = 928.250 minus bathroom 60 sq ft = 868.250 minus 131.418 (encumbered space) = 736.832 Room #C-9: (38.417 X 22.500) = 864.382 minus 77.281 (encumbered space) = 787.101 TOTAL INDOOR SPACE: 736.832 + 787.101 *= 1523.933* divided by 35 = 43 preschool children. *Since this School-Age Center will be operating on a functioning school site, A signed letter dated 5/16/2023 was provided by the Superintendent providing permission to use the rooms 50 and C-9. The Center is exempt from requirement of square-footage for indoor and outdoor activity space, and toilet, fencing, and isolation space requirements for child day care centers, pursuant to Health and Safety Code Section 1596.806.* The School-Age Center will operate Monday through Friday 6:30AM to 6:00PM, serving children ages TK to 6th Grade. Facility maintains telephone service: (408) 278-1876.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CATALYST KIDS - TRACE	FACILITY NUMBER: 434408743
	VISIT DATE: 08/08/2023

NARRATIVE

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A Fire Clearance inspection was approved on 8/4/2023 from the San Jose Fire Department. The Fire extinguishers in the rooms were last serviced on 6/2/2023. LPA also observed that the facility has working carbon monoxide and smoke detectors, and first aid kits.

Rooms 50, C-9 and restrooms and the outdoor areas were inspected. Children at the Center will have access to the restrooms, sinks, water on the school campus. There are restrooms located Inside of the class rooms. The children will be using the playground area for outdoor activities. LPA observed that the facility has a supply of play equipment for outdoor activities and outdoor activity space is enclosed with fencing and has shaded areas.

Restrooms for boys and girls are separated and provide individual privacy inside the room attached to the same building. Children will also be bringing their own water bottle and the Center has portable water dispenser to ensure that drinking water is available. Furniture and equipment for children to use were observed. There were tables and chairs for children to use. Weapons will not be stored on the premises and LPA did not observe any bodies of water on campus. The Center will not be providing transportation.

The Center will provide healthy snacks. Children will occasionally bring their own snacks when attending. LPA observed container used for storage of solid wastes has tight-fitting cover on. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored where they are inaccessible to children in care. Storage cabinets have locks. At the end of the day, facility will receive janitorial service provided by a third party.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) tollfree ADA Information Line at (800) 514-0301 (voice) or (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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CATALYST KIDS - TRACE	FACILITY NUMBER: 434408743
	VISIT DATE: 08/08/2023

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

FURNITURE LIST: 6 tables, 24 Lockers 1x3, 38 chairs and stools, 3 cubbies 1ft.x 4ft. each,

RESTROOMS: 4 sinks and 4 toilets.

LPA reviewed with Imelda Llorin the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA discussed the safe sleep regulations with Imelda Llorin and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed Imelda Llorin of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee understands that the license revision will require prior management approval.

Licensee is scheduled to open in the new room C-9 this Thursday 8/10/2023 and requesting a rush approval.

Exit interview conducted and report was reviewed with the Imelda Llorin.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC809 (FAS) - (06/04)

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