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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370562
Report Date: 03/24/2022
Date Signed: 03/24/2022 04:35:38 PM


Document Has Been Signed on 03/24/2022 04:35 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-STONEGATEFACILITY NUMBER:
304370562
ADMINISTRATOR:HALL, LEXIEFACILITY TYPE:
840
ADDRESS:100 HONORSTELEPHONE:
(949) 552-1872
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY:177CENSUS: 42DATE:
03/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Lexie Hall, Site SupervisorTIME COMPLETED:
04:45 PM
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An unannounced Case Management Inspection- Incident was conducted on this day by Licensing Program Analyst (LPA) Alanna Gontarek to follow-up on information received by the Department on an incident dated 3/14/22. LPA met with Site Supervisor, Lexie Hall who guided LPA on an indoor and outdoor tour of the facility. Census was taken. LPA went over Incident report with Site Supervisor, Lexie Hall. During the inspection today, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 7a.m.- 6p.m., Monday through Friday.

Facility representative was reminded that all adults 18 and over, 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 Child Care Center. 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.

The Department received an Unusual Incident Report (UIR), stating: On 3/14/22, at 4:50 p.m. C1 told S2 that C1 saw C1's father through the classroom window, and was going home. S2 looked out of the window and thought S2 saw C1's dad. At 5:00 p.m., C1's father came to pick up C1's sibling and told S2 that C1 had walked home a few minutes prior to C1's father picking up C1's sibling. C1 thought C1's family had already started walking home, and when C1 arrived at home, C1 realized C1's father had not gone to Catalyst to pick up C1 and C2 yet.

LPA observed 42 school age children and 5 staff in care on this date. LPA interviewed Site Supervisor and 2 additional staff members, and 2 children to obtain additional information and details regarding the incident report. LPA obtained supporting documentation, and noted observations. LPA obtained Declarations from: Site Supervisor, S2, and S3.

Based on insufficient information available at this time, the above mentioned Unusual Incident needs further Follow-up.
There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1 in regards to the above mentioned Unusual Incident Report.
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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-STONEGATE
FACILITY NUMBER: 304370562
VISIT DATE: 03/24/2022
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Exit interview conducted with Site Supervisor, Lexie Hall. A copy of this report (LIC 809) and Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.























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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
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