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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841029
Report Date: 07/19/2023
Date Signed: 07/19/2023 04:37:28 PM

Document Has Been Signed on 07/19/2023 04:37 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CATALYST KIDS - MENIFEEFACILITY NUMBER:
334841029
ADMINISTRATOR:RACHEL M SMITHFACILITY TYPE:
850
ADDRESS:25625 BRIGGS ROADTELEPHONE:
(951) 928-4000
CITY:MENIFEESTATE: CAZIP CODE:
92585
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: 56DATE:
07/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Rachel SmithTIME COMPLETED:
04:45 PM
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On July 19, 2023 at 1:15 pm, Licensing Program Analyst (LPA) Jessica Rubio arrived at the facility to conduct a case management visit to follow up on two unusual incident reports (UIR).

The first UIR was reporting that on 6/14/2023 in classroom four, child (C1) was running, bumped into another child, fell onto an easel and sustained a cut on their lip requiring stitches. LPA met with Director Rachel Smith as well as toured the facility and interviewed the two teachers (S1 & S2) present in the classroom at the time of the incident. Interviews revealed, S2 applied first aid to C1 and C1's parent was called and arrived shortly after to pick up C1.

The second UIR dated 6/20/2023, reporting that child (C2) had choked while eating a tostada shell while in classroom six. LPA interviewed the two staff (S3 and S4) present in the room at the time of the incident. Interviews revealed (S1) noticed C2 was red and appeared to be choking. S1 performed the Heimlich on C2 and also called for support from the front office. C2 did throw up the food after the Heimlich was performed and C2 was patted on the back. C2 was fine after that and had no other issues. The facility did contact C2's parent who picked up C2 at the regular pick up time. Director stated that the facility has not served the tostada shells since the incident and will now be serving soft tortillas.

Also while at the facility, LPA was informed of another unusual incident that occurred on 7/14/2023 inside classroom six involving child (C3). UIR reported C3 attempted to sit down on a bench at a table and bumped and cut their chin on the table, also requiring stitches. LPA interviewed two staff (S3 and S5) who were present in the classroom at the time of the incident. Interviews revealed S3 was sitting next to C3 when the incident occurred and C3 lost balance and fell into the table. S3 immediately applied first aid to C3. C3's parent was called and arrived shortly after to pick up C3.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CATALYST KIDS - MENIFEE
FACILITY NUMBER: 334841029
VISIT DATE: 07/19/2023
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Interviews for all three incidents revealed there were no issues with ratio and the facility usually has a 1:8 ratio. LPA determined there were no violations at this time and there were no deficiencies cited.

An exit interview was conducted and this report was reviewed with the Director Rachel Smith. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
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