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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561709946
Report Date: 04/08/2021
Date Signed: 04/08/2021 01:17:19 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: 9DATE:
04/08/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Robin O'TooleTIME COMPLETED:
01:15 PM
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On April 8, 2021 at 11:35 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 nine (9) children in care at the time of the inspection.

On March 12, 2021, C1 was playing on the playground with other children. C1 was playing on a stand alone slide that is about four feet high. The slide has a rock climbing setup to get to the top of the slide. According to the staff that observed the incident, C1 climbed up the slide and sat at the top. C1 was adjusting themselves and accidentally started to slide down. C1 slide down landing on their left forearm injuring themselves. Staff immediately attended to C1 and contacted their parent. It was later determined C1 had sustained a fracture.

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. Site Supervisor O'Toole advised that the slide is currently closed to the children. She advised that the staff plan to speak with the children and teach then how to appropriately use the slide before it can be used again.

No deficiencies were cited during today's visit.

A closing interview was conducted with Site Supervisor O'Toole. A copy of this report was reviewed and provided to via email. The delivered receipt confirmation from email will be in lieu of her signature once she received the report. LPA requested a signed copy be provided to Community Care Licensing

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: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
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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