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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415551
Report Date: 09/21/2022
Date Signed: 09/21/2022 04:27:58 PM

Document Has Been Signed on 09/21/2022 04:27 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 - BISHOPFACILITY NUMBER:
434415551
ADMINISTRATOR:FADILA MAHIOUZFACILITY TYPE:
850
ADDRESS:450 NORTH SUNNYVALE AVETELEPHONE:
(408) 739-2611
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY: 68TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
09/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ruma ChokshiTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Mel Matos met with Ruma Chokshi, director, for an unannounced case management investigation. Purpose of today's investigation: investigate an Unusual Incident that was self reported to the San Jose Child Care District Office on September 8, 2022.

LPA discussed the Unusual Incident with Ruma and a summarized copy of the corporate investigation report was provided to LPA prior to the conclusion of today's inspection.

Based on the available evidence, it is concluded that there is insufficient evidence to prove that the Unusual Incident did actually occur..

Exit interview conducted and report was reviewed with the Director, Ruma Chokshi. No deficiencies issued during today's inspection. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
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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