304370562-4-29-2022-06-CC-AGOK-CDXS3T-20220429133141

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370562
Report Date: 04/29/2022
Date Signed: 04/29/2022 01:31:48 PM

Document Has Been Signed on 04/29/2022 01:31 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-STONEGATE		FACILITY NUMBER:	304370562
ADMINISTRATOR:	HALL, LEXIE		FACILITY TYPE:	840
ADDRESS:	100 HONORS		TELEPHONE:	(949) 552-1872
CITY:	IRVINE	STATE: CA	ZIP CODE:	92620
CAPACITY:	177	CENSUS: 19	DATE:	04/29/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Lexie Hall, DIrector		TIME COMPLETED:	01:45 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

A Follow up Case Management Incident inspection was conducted on this day by Licensing Program Analyst (LPA) Alanna Gontarek. LPA met with Lexie Hall, Director who gave a tour of the facility. Census was taken. There were 19 school age children present upon arrival. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearances or exemptions and a child abuse index clearance.

The initial inspection was conducted in response to an Unusual Incident Report received on 3/23/2022, in which child #1 had left the classroom and walked home on 3/14/22. Director filed report with the Department on 3/14/22. This incident was reported to licensing in a timely fashion, compliant with reporting requirement regulations. An inspection was conducted on 3/24/2022, to investigate into this unusual incident.

During the course of the investigation, staff involved in the unusual incident report were interviewed, a physical plant inspection was conducted, and census of children was taken. During the inspection on 3/24/22, the facility had 4 staff and 20 children present.

During the investigation, LPA was able to determine that child #1 (C1) had wandered away, through the Elementary playground and out of the facility. C1 stated C1 saw C1’s authorized representative outside of classroom. Teacher (S2) stated that C1 walked home daily with C1’s authorized representative. S2 stated, S2 released C1 at approximately 4:50 p.m., assuming C1’s authorized representative had arrived to pick up C1. S2 did not verify if C1’s authorized representative was there to pick up C1. S2 also did not verify if C1 had been checked out before releasing C1. During interview conducted with C1, C1 stated C1 thought C1 saw C1’s father arrived, and informed S2. S2 stated approximately 5 minutes after C1 left facility, C1’s authorized representative came into S2’s classroom stating C1 walked home. During interviews conducted, it was confirmed that C1 walked to C1’s house alone, approximately 0.5. miles away from the school.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Alanna Gontarek	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: 04/29/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 2:

During record review, LPA observed the children’s Sign in and Sign out sheets on day of the incident (3/14/22), and the Sign Out sheet revealed C1 was signed out by C1’s authorized representative at 5:00 p.m.

Based on the information obtained during today's inspection regarding this reported incident, it was determined that the facility violated Title 22 Regulations related to Supervision. C1 walked out of the facility, alone, and was unsupervised for approximately 10 minutes until C1 reached C1’s home. A violation for a lack of supervision was issued, as this has been determined to be an immediate threat to the children's health and safety. Please see attached LIC 809D and civil penalty pages. An Immediate Civil Penalty is being assessed today.

LPA Alanna Gontarek informed Director, Lexie Hall that this report dated (4/29/22) documents 1 Type A citation. Type A citation shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Alanna Gontarek informed the licensee Director, Lexie Hall to provide a copy of this licensing report dated (4/29/22) that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Director, Lexie Hall.

Notice of Site Visit was posted during the visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.The facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. This report is to be on file and accessible for public review at the facility for at least 3 years.

-Report Ends Here-

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Alanna Gontarek	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3

Document Has Been Signed on 04/29/2022 01:31 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-STONEGATE	FACILITY NUMBER: 304370562
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/29/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/02/2022 Section Cited	1 2 3 4 5 6 7	(a) The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced
	8 9 10 11 12 13 14	by: S2 did not verify if C1’s authorized representative was there to pick up C1. Staff #2 (S2) did not C1 walked out of the facility, alone, and was unsupervised for approx. 10 minutes until C1 reached C1’s home. This poses an immediate health safety, and personal rights risk to the children in care. Immediate Civil Penalty was assessed.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Alanna Gontarek	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3