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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415551
Report Date: 09/21/2023
Date Signed: 09/21/2023 01:54:58 PM

Document Has Been Signed on 09/21/2023 01:54 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:RUMA CHOKSHIFACILITY TYPE:
850
ADDRESS:450 NORTH SUNNYVALE AVETELEPHONE:
(408) 739-2611
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY: 68TOTAL ENROLLED CHILDREN: 30CENSUS: 19DATE:
09/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Ruma ChokshiTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Mel Matos met with Ruma Chokshi, Director, for an unannounced case management inspection. Purpose of today's inspection: investigate an Unusual Incident that the Facility self reported to the Department on August 16, 2023.

Director states that the incident occurred on August 14, 2023 at 9 AM. Director states that a preschool child started crying and pointed to her private area when the master teacher asked the child what was wrong. Director states that the child told the master teacher that the child's private area hurt. Director states that she and the master teacher did a wellness check on the child and did not observe any visible signs of injury. Director states that the master teacher provided the child with an ice pack to apply and states that the child was back playing with the other children within a few minutes.

Director states that the child was fine the rest of the day and did not complain of any pain or discomfort to staff after the initial incident. Licensee states that the closing teacher did provide a copy of the ouch report to the child's aunt (listed as an authorized person on file) at pick up time on August 14, 2023. A copy of the ouch report was provided to LPA during today's inspection.

Director states that the child's mother left her a voice mail message the following day, August 15, 2023, inquiring why she had not been notified via telephone of the incident from the day before. Director states that she immediately called the child's mom and apologized for the incident. Director states that she concluded that the incident did not warrant an immediate call to the parents since the child was fine shortly thereafter and did not complain of any pain or discomfort after the initial incident.

Director states that the child's mom told her that the child was doing fine and that she would call back with doctor's information. Director states that the child's mother never called her back and states that the child has not returned to the Facility since August 14, 2023.

Based on the available evidence, it is concluded that the Facility provided a copy of an ouch report to the child's authorized person for pick up at pick up time on August 14, 2023, and thus there is no violation of Title 22 regulations.

Exit interview conducted and report was reviewed with the Director, Ruma Chokshi. 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: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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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