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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400234
Report Date: 12/21/2023
Date Signed: 12/21/2023 04:03:33 PM

Document Has Been Signed on 12/21/2023 04:03 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 - P.A. WALSHFACILITY NUMBER:
434400234
ADMINISTRATOR:DARIANI, SALVADORFACILITY TYPE:
850
ADDRESS:353 WEST MAIN AVENUETELEPHONE:
(408) 778-2896
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 40TOTAL ENROLLED CHILDREN: 16CENSUS: 10DATE:
12/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:28 PM
MET WITH:Lorena DominguezTIME COMPLETED:
04:13 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Cortney Nelson and Liridon "Doni" Fici, met with Center Manager, Lorena Dominguez, to follow-up on incident self-reported to the Department on 12/8/2023. Upon arrival, LPAs were admitted into the facility by staff, Nayely, and advised that Lorena is on her way.

On 12/8/2023, the facility reported that C1 ran out of the facility and was unable to be retrieved for approximately 8 minutes. The incident occurred around 5:00PM and due to dark conditions, as the sun had already set, the staff lost sight of the child while attempting to return her to the facility. Police and parents of the child were notified and C1 was found at another after-school program operating at the same elementary school campus. At the time of the incident, there were two staff members (S1 & S2) and twelve (12) children present.

LPAs toured the facility with Lorena, who identified the room in which the child ran from and the area in which the child was located. Lorena states C1 ran from the room and S1 advised the child not to run in the street as it is not safe. C1 ran back towards the facility and around the back to the elementary school campus where she was lost from visual sight as the sun had already set.

A plan has been created for C1 moving forward to prevent the child from running from the facility again. LPAs advised closing the gates accessing the main road outside of the facility as it is open during operating hours for parents to park. Lorena states that they are additionally considering locking the side gate that provides access to the elementary school yard. Moving forward, the facility plans to follow the plan developed for C1 and ensure that there are always at least two staff members present while children are in care. The behaviors of C1 have also been observed by staff from the elementary school and Lorena states the follow-up plan will be consistently utilized by the day care, elementary school, and at home.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
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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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 - P.A. WALSH
FACILITY NUMBER: 434400234
VISIT DATE: 12/21/2023
NARRATIVE
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LPAs informed licensee (Lorena Dominguez) that this report dated (12/21/2023) documents one Type A citation which shall be posted for 30 consecutive days as there are immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs informed the licensee to provide a copy of this licensing report dated (12/21/2023) that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

As a result of todays inspection, a deficiency has been cited, see LIC809-D.

Exit interview conducted and report was reviewed with the Center Manager, Lorena Dominguez.

A NOTICE OF SITE VISIT HAS BEEN GIVEN AND SHALL BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 12/21/2023 04:03 PM - It Cannot Be Edited


Created By: Cortney Nelson On 12/21/2023 at 03:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CATALYST KIDS - P.A. WALSH
FACILITY NUMBER: 434400234

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/22/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supevision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time.. supervision shall include visual observation.

This requirement was not met as evidenced by:
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The Center Manager states that a behavior plan has been developed for C1 and shall be implemented at home, school and the day care. The staff are aware of C1 and her behaviors and will work with her more directly.
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The Licensee did not ensure that children are visually supervised at all times as a child ran from the facility and was not visually supervised for approximately 5-8 minutes, which poses an immediate risk to the health, safety, and personal rights of children in care.
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LPAs advised Type A requirements per AB633, including signature on LIC9224.

-civil penalities assessed-

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023


LIC809 (FAS) - (06/04)
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