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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416392
Report Date: 11/04/2022
Date Signed: 11/04/2022 02:17:02 PM

Document Has Been Signed on 11/04/2022 02:17 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 - STIPEFACILITY NUMBER:
434416392
ADMINISTRATOR:QUY NGUYENFACILITY TYPE:
850
ADDRESS:5000 LYNG DRIVETELEPHONE:
(408) 412-5486
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 8DATE:
11/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Director (site supervisor) Salinas Rodriguez, MonicaTIME COMPLETED:
02:30 PM
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On this day Licensing Program Analyst/s (LPA/s) Almaraz, Celi conducted an unannounced annual random inspection. Due to COVID- 19 precautionary measures were taken. This facility is currently licensed for a capacity of 42. Licensing staff met with acting Director (site supervisor) Salinas-Rodriguez, Monica and explained the nature of today’s inspection. This is a preschool program that currently operates from 7AM to 6 PM, Monday thru Friday. Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. At the initial start of this visit, there was a total census of 8 preschoolers and a total census of two staff, including one Director, and one fully qualified teacher present. This program is on the Stipe elementary school campus.

Physical Plant: All areas identified on the Facility Sketch were inspected. This preschool program consists of the following classrooms: Room A (152A) & Room B (152B): Room A: Due to low enrollment, this room is currently not being used. Per Director a class will be operating based on enrollment needs. No hazards were observed, there is a gate to separate classrooms.

Room B: This classroom currently operates as a full day classroom. Staff # 1 a fully qualified teacher and eight preschool children. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to one sink inside the class. The two rooms are adjacent to one another, with a centralized lavatory in between.
All classrooms observed to have suitable furniture and equipment, which were inspected for age appropriateness. All classrooms observed to have sufficient have telephone services, heating, lighting, and ventilation.

General sanitization & safety: Preschoolers have their own cubby to store their belongings. Per Director, sick children are isolated in Room A, during full enrollment, children will be isolated in “calm area” of the classroom in accordance with Santa Clara county Public Health guidelines. 1/6
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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 - STIPE
FACILITY NUMBER: 434416392
VISIT DATE: 11/04/2022
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LPA advised Director that all storage containers for solid waste, including moveable trash receptacles must have tight-fitting covers that are kept on, and in standard condition, LPA observed there are foot petals to open trash bins. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Filtered and bottled water is available for children in care. Disinfectants, cleaning solutions, medication and other hazardous items that pose a risk to children, were inaccessible to the children in care, locked in upper cabinets. Director states that poisons are locked in the custodian. No bodies of water or other hazards were observed during inspection. Director understands smoking is prohibited. Per Director there are no firearms on site.

Kitchen: The kitchen area is in Room B. All kitchen areas/food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. Water and refrigerator temperatures in standard condition. Director states waste is to be discarded immediately after each meal.

Food: Menus are posted on site one month in advance, in each classroom. Menus for the past one year are available upon request. Facility provides Snacks (AM/PM), breakfast and lunch. LPA reviewed food for availability, quantity and appropriateness to children in care. Per Director, all meals are prepared on-site. Snacks and supplemental food with 5 components kept on site. Per Director there is an allergy list for each child posted in kitchen area. LPA and director Discussed a name to face and allergy, system to be posted in kitchen area for best practice. Director states there currently no children enrolled that have allergies. Food from home is allowed and must be labeled.

Lavatories: There are two children's lavatories, beside one another, in proximity to each classroom. There are two toilets and no sink on the Room A side. Per Director, this lavatory is currently being used as a staff lavatory and/or to isolate a sick child. During full enrollment, staff will use the bathroom on the main campus and children will wash hands inside of classroom A. A sick child will use the staff bathroom to isolate. There is one toilet and one sink on the classroom B side. All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. All hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. The facility is currently not providing potty training but does as needed. LPA and Director discussed potty training seats. 2/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
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 - STIPE
FACILITY NUMBER: 434416392
VISIT DATE: 11/04/2022
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Outdoor Playground: Equipment is in safe condition, free of sharp, defective or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. There is no high climbing equipment, swings, slides, and similar equipment. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. Per Director children are provided with bottled water. There is a sandbox covered with a tarp when not in use. Director states this sandbox is currently not in use, if used, it is to be inspected daily or before use. There is a locked storage in the playground, where bikes and supplies are kept.

Facility Records: All individuals present have obtained a criminal record clearance or criminal record exemption. All staff have received an active criminal record clearance as a condition of their employment. LPA/s issued Review of Staff records (LIC 859) to the Director during this inspection. At least one staff (Director) has record of CPR and First Aid, valid until 01/28/2023. All staff present have the following: MMR & Tdap vaccinations, flu vaccine or the opt out. All staff has completed Mandated Reporter Training, Director’s training valid thru 04/06/2024. Directors understand this must be renewed every two years. Directors permit valid thru 11/01/2025. LPA/s reviewed 2 children's files and issued an LIC 857. LPA reviewed 2 staff files total. All files were observed to have complete information but will require some updating.

Supervision: All children were observed to be under visual supervision of a teacher at all times. Per Director there is no transporting of children in care.

Sign in and out: Procedures were reviewed by LPA/s to ensure that children who are present where sign in. Facility uses an electronic sign in/sign out system. LPAs obtained a roster and personnel report at the conclusion of this inspection.

Waivers: There are no known waivers of file.

Medical & First Aid Supplies: There is a first aid kit in each classroom, kept in rolling backpack. LPA reviewed kit to ensure supplies are complete. Director states that supplies are checked once a year or as needed. There is a fanny pack with supplies that is checked monthly. Per Director medication is only administered to a child when accompanied with a doctor's note, parent plan, authorizations are to be completed monthly. Any medication is kept in a locked cabinet and/or in emergency rolling backpack when outside also stored inaccessible of children. 3/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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 - STIPE
FACILITY NUMBER: 434416392
VISIT DATE: 11/04/2022
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Per Director there are currently no children enrolled who required Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Fire & Safety: Carbon monoxide detectors and smoke detectors are working and present in the facility, the fire department conducted a fire inspection on 04/2022 (no day of the month indicated). There are Fire extinguishers, size 3A40BC in each room, last serviced 04/2022; last fire drill conducted on 10/20/2022. Director understands this is to be completed every six months.

Matts and cots: Cots inspected for napping and were observed to be maintained in a safe condition with no exposed foam. Constructed of material at least 3/4 inch thick. Covered with vinyl or similar material that can be wiped. Designed so that the sleeping side can be distinguished from the floor side. Per Director cots are wiped weekly with a detergent, disinfectant or when soiled or wet. Each cot observed to be equipped with a sheet and/or blanket to cover the child. Per Director bedding is not shared and sent home each Friday (or when soiled) to be laundered. LPA reminded Director that bedding shall be individually stored so that each child's bedding is identifiable, and no child's used bedding shall meet other bedding. Bedding is stored in individualized baskets, so as not to touch.



Lead Testing: Director states a certified external water sampler took a sample in August or September. Per Director, it is not known when the results will come. This was done through the Catalyst main office. Director understands providers must submit the LIC 9275, a completed signed and dated childcare sampling checklist form LIC 9276 and a facility sketch LIC 999 fully labeled with locations of all water outlets to their LPA and self-report testing results. There is currently no water supply capped off. LPA and Director discussed supply must be capped off if lead is found in source. 4/6
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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 - STIPE
FACILITY NUMBER: 434416392
VISIT DATE: 11/04/2022
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Per Director, there has been no suggestion of capping off any water supplies. There is a filter that is used to serve any water. The filter is replaced every quarter or three months.

LPA advised Director to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. For commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Postings: Parent’s Rights Poster (with complaint Hotline) was observed during this inspection. LPA observed all required postings, including license and emergency disaster plan. LPA and Director discussed updating relocation site off premises in the event of an emergency, Director will fill out form and post on or by the end of the day.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

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.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a childcare facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers 5/

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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 - STIPE
FACILITY NUMBER: 434416392
VISIT DATE: 11/04/2022
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The following was discussed:
· Reporting Requirements.
· The facility shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations.
· All personnel shall be in good health and shall be physically and mentally capable of performing assigned tasks; personnel that pose a threat to the health and safety of children shall be relieved of their duties.

All personnel shall be given on the job training in housekeeping, sanitation principles and universal health precautions.

LPA advised the facility representative to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

There are NO deficiencies being cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes.

LPA and Director discussed the following: 1. Name to face food allergy list. 2. De-clutter and organize Room B play area. 3. Update personnel forms for staff. 4. Update licensing forms for children files for those currently enrolled. 5. Update relocation site, which currently has a another child care center. 6. Confirm current Director and inform Licensing if information has changed. Director understands that while facility is currently in compliance, failure to take such measures may result in future citations. Director will send photos via email to LPA, this shall be complete within four weeks and understands LPA may conduct an unannounced case management to inspect the facility for updates.

A notice of site visit was issued and must remain posted for 30 consecutive days.

Exit interview conducted and report was reviewed with facility representative. 6/

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC809 (FAS) - (06/04)
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