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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561709242
Report Date: 03/08/2022
Date Signed: 03/08/2022 12:24:02 PM


Document Has Been Signed on 03/08/2022 12:24 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CATALYST KIDS- PORTOLAFACILITY NUMBER:
561709242
ADMINISTRATOR:ROSA CORTEZFACILITY TYPE:
840
ADDRESS:1350 PARTRIDGE DRIVETELEPHONE:
(805) 644-1624
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:35CENSUS: 0DATE:
03/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Cassandra AlvarezTIME COMPLETED:
12:38 PM
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On 3/8/2022 at 11:45 AM , Licensing Program Analyst (LPA) Austin Rios and (LPA) Rona Chavez conducted an unannounced Case Management inspection. LPA met with facility supervisor Cassandra Alvarez and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were zero children in care at the time of the inspection.

On 2/28/2022 Child was sliding down the slide, tripped over their shoe, fell and landed on left hand. Staff iced the hand and kept the hand E-mobile. Staff felt on the outside of the left wrist and it felt like it was broken. Staff, on a walkie Talkie called for another teacher, then called parent to pick up child and was taken to the hospital.

Today, LPA inspected the area and observed where the incident took place as. The Director reported the incident and submitted the incident report to the Department as required.

LPA’s observed the area where in the incident took place. Play equipment and slide was in good condition. Under the slide had proper cushioning. There was 1 staff outside during the incident and five children. Staff observed the incident take place and immediately attended to the child.

Based on the information obtained, it is determined no violations have occurred, thus no deficiencies are cited during this inspection.

A notice of site visit was given.

Failure to Post the Notice of Site Visit for 30 days may result in a $100.00 Civil Penalty.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
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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