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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370115
Report Date: 04/25/2024
Date Signed: 04/25/2024 02:22:54 PM

Document Has Been Signed on 04/25/2024 02:22 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-HICKS CANYONFACILITY NUMBER:
304370115
ADMINISTRATOR/
DIRECTOR:		RAIBON, KRISTENFACILITY TYPE:
840
ADDRESS:3817 VIEW PARKTELEPHONE:
(714) 544-3492
CITY:IRVINESTATE: CAZIP CODE:
92602
CAPACITY: 140TOTAL ENROLLED CHILDREN: 56CENSUS: 9DATE:
04/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Center Manager-Tim BongcoTIME VISIT/
INSPECTION COMPLETED:
02:21 PM
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An unannounced Case Management inspection conducted on this date by Licensing Program Analyst (LPA) Navar to provide the facility a copy of an amended LIC 809 report dated 04/05/2024 and obtain signatures. LPA observed 2 staff caring for 9 school age children.

A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

Please see "Amended" LIC 809 report dated 04/05/2024 for corrections.

There were no Title 22 deficiencies cited during today's inspection.

Exit interview was conducted with Center Manager Tim Bongco Notice of Site Visit was posted during the visit. Licensees was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Licensees was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024
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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