<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270423
Report Date: 04/23/2024
Date Signed: 04/23/2024 04:22:33 PM

Document Has Been Signed on 04/23/2024 04:22 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CATALYST KIDS-PETERS CANYONFACILITY NUMBER:
304270423
ADMINISTRATOR/
DIRECTOR:		MENDIZABAL, ALICIAFACILITY TYPE:
840
ADDRESS:26900 PETERS CANYON ROADTELEPHONE:
(714) 731-1779
CITY:TUSTINSTATE: CAZIP CODE:
92782
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: DATE:
04/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Program Lead-Alicia Mendizabal TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 4/23/2024 an unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Karen Navar in response to a self reported incident dated 04/03/2024. This is a continuation of the initiated inspection on 04/09/24. LPA met with Program Lead Alicia Mendizabal. Program Lead took LPA on tour of the facility and census was taken in the classroom. The overall census observed was 16 school age children and 3 staff members during check in time.

A review of adult records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Today's Case Management inspection is being conducted in response to a self-reported incident, reported to the OC CCL office on 04/03/2024, reporting that 1 staff member was left with 17 children in care.

During the investigation, LPA obtained a copy of the children’s roster, reviewed Unusual Incident report with program lead, and interviewed 3 staff members.

Interviews conducted with 3 staff members S1-S3 stated that 1 staff member was left alone with 17 children. This is an immediate health, safety and personal rights risk to children in care. S1 stated that they thought they were following the regulation from Title 22 18292 and believed that they had 120 minutes to be out of ratio for emergency purposes. LPA reviewed Title 22 regulation Section 101516.5(b)(1) Teacher-Child Ratio with S1 and explained that 18292 is a Title 5 regulation.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE: DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CATALYST KIDS-PETERS CANYON
FACILITY NUMBER: 304270423
VISIT DATE: 04/23/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2
Based on LPAs observations, record review, and interview. It is determined that 1 staff member was left with 17 children. The facility was not in compliance and will be cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 101516.5(b)(1) Teacher-Child Ratio. See attached LIC809D.

This report cites a Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

Exit interview conducted with Program Lead Alicia Mendizabal. A copy of the Appeal Rights (LIC 9058 FAS 01/16) was given and explained. Program Lead signature on this form acknowledges receipt of the report (LIC 809). A Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

End of Report

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/23/2024 04:22 PM - It Cannot Be Edited


Created By: Karen Navar On 04/23/2024 at 03:40 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CATALYST KIDS-PETERS CANYON
FACILITY NUMBER: 304270423

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/23/2024
Section Cited
CCR
101516.5(b)(1)

1
2
3
4
5
6
7

101516.5 Teacher-Child Ratio
(b)There shall be a staffing ratio...(1) A teacher shall supervise no more than 14 children....

This requirement was not met as evidence by:
1
2
3
4
5
6
7
Created an action plan with steps to follow when a child is missing. I have reviewed with the 2 staff members who have signed the document.
8
9
10
11
12
13
14
Based on records review and interviews conducted. S1-S3 stated that 1 staff memeber was left with 17 children in care. This is an immediate health, safety and personal rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Judy Hanson
LICENSING EVALUATOR NAME:Karen Navar
LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3