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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561709946
Report Date: 03/09/2021
Date Signed: 03/09/2021 05:06:35 PM

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- MOUNDFACILITY NUMBER:
561709946
ADMINISTRATOR:DEBORAH DORFMANFACILITY TYPE:
840
ADDRESS:455 S. HILL RD.TELEPHONE:
(805) 650-8791
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:79CENSUS: 17DATE:
03/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:57 PM
MET WITH:Robin O'TooleTIME COMPLETED:
04:30 PM
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On March 9, 2021 at 10:30 AM, Licensing Program Analyst (LPA) Francisco Pedroza conducted a case management inspection. LPA met with Site Supervisor Robin O'Toole and advised her the purpose of the inspection. Due to COVID-19 and the Department of Public Health guidelines, a tele-inspection was completed via Facetime. Site Supervisor provided LPA a tour of the facility. There were 17 children in care at the time of the inspection.

On March 4, 2021 at around 4:26 pm. C1 was playing on the playground with other children. C1 had went down the slide. Before C1 could get off the slide, C2 went down bumping C1 off. Staff observed the incident and immediately went to check on C1. Staff did not notice any swelling or injury. Staff observed C1 was favoring their right ankle. Staff escorted the child to the office and placed ice on their right ankle. The child's grand parent arrived within 10 minutes of the incident when the child was in the office because it was the child's normal pick-up time. The child's grandmother was informed of the incident. Later that evening the parents observed swelling on C1's ankle and took them to be evaluated by the doctor. C1 was diagnoised with a small sprain to their right ankle. C1 returned back to the facility on March 8, 2021. There were no restrictions required by the doctor. Site Supervisor advised the child has been doing well and playing with the other children.

Given the facility staff's account of the incident when reporting it to Community Care Licensing and how they addressed the incident, LPA deemed licensee's action was appropriate.

No deficiencies were cited during today's visit.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2021
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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