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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270423
Report Date: 04/09/2024
Date Signed: 04/09/2024 03:59:24 PM


Document Has Been Signed on 04/09/2024 03:59 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:MENDIZABAL, ALICIAFACILITY TYPE:
840
ADDRESS:26900 PETERS CANYON ROADTELEPHONE:
(714) 731-1779
CITY:TUSTINSTATE: CAZIP CODE:
92782
CAPACITY:70CENSUS: 0DATE:
04/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Alicia Mendizabal TIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Karen Navar conducted an on-site inspection for the purpose of a Case Management Incident Inspection on 04/09/2024 LPA toured the facility with Program Lead Alicia Medizabal. Census was taken in individual classrooms, there were 0 school-age children present upon arrival and 2 staff. 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, due to ratio.

An on-site Facility Personnel Report Summary review showed that all facility staff or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions.

LPA inspected classroom and children’s check in procedure with Program Lead. Regional Director Eva Tarin arrived at 2:55PM and met with LPA to discuss the UIR regarding ratio.

During the investigation LPA Navar interviewed 3 staff members. LPA requested a current Children’s Roster LIC9040 and updated Personal Roster LIC500.

Due to insufficient information available at this time, the above allegations need further investigation.

The exit interview was conducted with Regional Director, Eva Tarin. Notice of Site Visit was posted during the visit. Regional Director 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 Regional Director was provided with 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.

End of Report

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Karen NavarTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
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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