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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270709776
Report Date: 06/30/2021
Date Signed: 06/30/2021 02:17:02 PM

Document Has Been Signed on 06/30/2021 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 - KING CITY MIGRANTFACILITY NUMBER:
270709776
ADMINISTRATOR:PATRICIA REYESFACILITY TYPE:
830
ADDRESS:440 JAYNE STREETTELEPHONE:
(831) 385-4005
CITY:KING CITYSTATE: CAZIP CODE:
93930
CAPACITY: 22TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
06/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Patricia TejedaTIME COMPLETED:
02:30 PM
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On 06/30/2021 at 10:00 AM, Licensing Program Analyst (LPA), Susy Cervantes, conducted an unannounced annual visit to the Facility today. LPA met with Patricia Tejeda, director, and explained the nature of today’s visit. LPA toured the Facility both inside and outside during today’s visit. The facility has a preschool license on site (#270703764). LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents’ Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. The days and hours of operation are Monday - Friday 5:00 AM - 6:00 PM.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 06/28/2021 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA also reminded them of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.

LPA observed Infant Needs and Services, medical assessment and the Information and Emergency Information form (LIC 700) in 3 children’s files. LPA observed the required health screening, immunizations, mandated reporter training and first aid/CPR in two staff files. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times.

Continues on report dated 06/30/2021
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2021
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 - KING CITY MIGRANT
FACILITY NUMBER: 270709776
VISIT DATE: 06/30/2021
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Continuation of report dated 06/30/2021

LPA reviewed the sign-in, sign-out sheets for the past 30 days and Child Care Facility Roster (LIC 9040) and all were in compliance. LPA observed that the teacher/child ratio was in compliance during today’s visit. LPA observed 4 teacher with 9 infants in the infant room.

LPA observed that the room is clean and safe for all children and staff. Drinking water is readily available for the children in each room and in the outdoor playground area via drinking fountains. LPA observed a 3A40BC fire extinguisher that was last serviced on 05/17/21 and a functioning Carbon Monixide detector. LPA observed solid waste containers with tight-fitting lids in each room and in the playground area. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children. Director states that there are no weapons on the premises.

The food preparation area is adequately equipped with ovens, refrigerators, and hot and cold running water. Cleaning supplies are stored inaccessible to the children. Medication is stored in the kitchen. LPA reviewed the Facility’s medicine log and medication lock box during today’s visit. LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and is separate from the preschool play are. LPA observed that the outdoor equipment is age appropriate and in good condition. LPA did not observe any bodies of water. LPA discussed and provided the director the Individual Infant Sleep plan (LIC 9227) as well as discussed the requirement to log 15 minute checks while infants sleep.

LPA discussed Zero Tolerance with $500 civil penalty and the requirements of AB633 with the director and discussed the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and they understand the requirements. Licensing Forms, Title 22 Regulations and Information can be obtained through the internet at www.cdss.ca.gov.

LPA conducted an exit interview with Director. No deficiencies cited during today's inspection. NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
LIC809 (FAS) - (06/04)
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