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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300614059
Report Date: 10/25/2021
Date Signed: 10/25/2021 05:27:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CATALYST KIDS-TURTLE ROCKFACILITY NUMBER:
300614059
ADMINISTRATOR:HO, MINDYFACILITY TYPE:
840
ADDRESS:5151 AMALFI DRIVETELEPHONE:
(949) 854-5060
CITY:IRVINESTATE: CAZIP CODE:
92603
CAPACITY:70CENSUS: 22DATE:
10/25/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Site Supervisor - Mindy HoTIME COMPLETED:
05:40 PM
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Licensing Program Analyst (LPA) Corral conducted a Case Management Inspection to investigate an Unusual Incident Report (UIR) which was self-reported to our office on 10/20/2021. Prior to entering the Facility LPA Corral reviewed the COVID-19 Questionnaire with Site Supervisor, Mindy Ho. Upon entry to the facility, LPA Corral met with Mindy Ho, where 22 school children were observed in care with 3 staff members providing care and supervision. Due to COVID 19 Guidelines, LPA Corral observed staff members wearing face masks, social distancing and following CDC and Dept of Public Health Guidelines. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on 10/22/2021 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The Self-reported incident received on 10/20/2021 stated a 9-year-old child (C1) left the Facility without informing Facility staff. Based on information that was obtained the Facility was unaware of C1’s whereabouts for about 50 minutes. LPA Corral conducted this inspection to request additional information and documentation. The Facility Roster (LIC 9040), C1’s File, a Site Supervisor Declaration (LIC 855) and the Unusual Incident Report (LIC 624), along with C1 and C2 sign in/sign out record were requested. An interview with Site Supervisor Mindy Ho was also conducted. C1 and C2 were also interviewed. Further Record Review is required.

The Notice of Site Visit was posted. Site Supervisor 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. The Site Supervisor was provided a copy of their Appeal Rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Site Supervisor was informed all appeals must be in writing and received by the Licensing office within 15 business days.
End of Report.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen CorralTELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2021
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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