304270423-3-8-2023-06-CC-PRIS-CPR2RG-20230308163732

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270423
Report Date: 03/08/2023
Date Signed: 03/08/2023 04:39:48 PM

Document Has Been Signed on 03/08/2023 04:39 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	CATALYST KIDS-PETERS CANYON		FACILITY NUMBER:	304270423
ADMINISTRATOR:	MENDIZABAL, ALICIA		FACILITY TYPE:	840
ADDRESS:	26900 PETERS CANYON ROAD		TELEPHONE:	(714) 731-1779
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92782
CAPACITY:	70	CENSUS: 18	DATE:	03/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Melissa Fraga, Teacher & Alysha Morgan, Site Supervisor		TIME COMPLETED:	04:50 PM

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Licensing Program Analyst (LPA) P Rivas conducted an unannounced annual inspection and was met by Melissa Fraga and together conducted tour of facility. Facility is located in two portable units#1 & 2 within Peters Canyon Elementary School. Site Supervisor Alysha Morgan arrived shortly to provide support . Site Director Ms. Mendizabal was out until Monday. Licensee was operating within the licensed capacity as specified on license. Hours of operations are Monday- Friday 7:00 AM – 6:00 PM.
Licensee was reminded that all adults 18 and over living or working in the facility , including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A review of the Facility Personnel Report Summary conducted on 03/08/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. All staff are fingerprinted and associated to Catalysts Kids LIndbergh 304270761

A physical plant tour was conducted, LPA reviewed 2 rooms, 2 bathrooms were inspected and found to be in compliance. The facility has conducted an emergency drill on 02/09/23. The facility has a working carbon monoxide detector and fire extinguisher(serviced 09/22). Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility . Based on capacity, two restrooms with one sink and one toilet is insufficient . However, Ms. Morgan indicated they are allowed to use school restrooms. LPA inspected restrooms and in girls room there are 4 toilets and 2 sinks; In boys restroom there are 2 urinals, 2 toilets and 2 sinks. None of the stalls are designated for facility's use. LPA was further

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CATALYST KIDS-PETERS CANYON	FACILITY NUMBER: 304270423
	VISIT DATE: 03/08/2023

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advised that the restrooms in the school were allowed at the pre-licensing visit. Due to pre licensing visit being archived LPA will have to verify that school restrooms were available to allow for capacity of 70.

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material is play and pour around the climbing equipment, swings, slides and other similar equipment appeared to be enough to absorbs falls. Use of outside play space allowed after school hours. Drinking water in the outdoor activity space is provided by water bottles with the child’s name on it . The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.

Staff files were reviewed for staff present during the facility inspection on this date, 05 out of 05 staff files were reviewed. Health screening and immunization's as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1596.7995 states, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff were reviewed and within compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed child care providers, administrators, or employees of a licensed child day care facility to complete the mandated reporter training, and to renew the training every two years. Requirement was met . At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 11/18/2024.
Children's records were reviewed, and there was a separate, complete and current record for each child. 05 of 05 children's files were reviewed for documentation of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached when necessary (emergency sheet) and a medical assessment. LPA advised to have all forms updated to reflect current licensee name.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CATALYST KIDS-PETERS CANYON	FACILITY NUMBER: 304270423
	VISIT DATE: 03/08/2023

NARRATIVE

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Facility provides Incidental Medical Services. LPA viewed proper storage and documentation. Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The director was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2022/CCP/PIN-22-06-CCP.pdf

CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

In the areas that were evaluated, one deficiencies was observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. Citation will be issued on 809d for 101216(g)1 Personnel Requirements Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CATALYST KIDS-PETERS CANYON	FACILITY NUMBER: 304270423
	VISIT DATE: 03/08/2023

NARRATIVE

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Exit interview conducted and report was reviewed with Site Supervisor Alysha Morgan. Appeal Rights and were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/08/2023 04:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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-PETERS CANYON	FACILITY NUMBER: 304270423
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements 1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in 1 out of 3 staff files reviewed staff #2 did not have a tb test or clearance on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/17/2023
	Plan of Correction
1 2 3 4	licensee will have staff#2 obtain a tuberculosis test with results and provide copy to LPA by plan of correction date

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

LIC809 (FAS) - (06/04)

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