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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270320
Report Date: 05/03/2024
Date Signed: 05/03/2024 02:51:49 PM

Document Has Been Signed on 05/03/2024 02:51 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CATALYST KIDS-SYCAMOREFACILITY NUMBER:
304270320
ADMINISTRATOR/
DIRECTOR:		BALMACEDA, NURYFACILITY TYPE:
840
ADDRESS:1402 SYCAMORE AVENUETELEPHONE:
(714) 258-8524
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 105TOTAL ENROLLED CHILDREN: 59CENSUS: 0DATE:
05/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Center Manager-Nury BalmacedaTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
NARRATIVE
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On 05/03/2024 an unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) K. Navar in response to a self reported incident dated 04/15/2024. LPA met with Center Manager Nury Balmaceda. Center Manager took LPA on tour of the facility and census was taken in individual classrooms. The overall census observed was 0 school age children and 4 staff members.

A review of adult records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Today’s Case Management inspection is being conducted in response to a self reported incident, reported to the OC CCL office on 04/15/2024, reporting a child was left unsupervised during transition time from outside to the classroom. It was reported the child was behind the backpacks and left outside and teacher was in the classroom. Child stated to teacher “You left me outside.”

During the inspection, LPA obtained a copy of the children’s roster, reviewed Unusual Incident report with Center Manager, conducted a physical plant inspection where the child was left unsupervised.

Interview with staff: On 5/03/2024, the LPA interviewed 1 staff. Staff #1 (S1) said that there were 7 children in ratio and that they were transitioning from homework time to open recreation time and had gone outside to put their belongings away. During this transition time 2 staff were in the classroom and 1 staff was standing in the door between the classroom and outside ramp. S1 said the staff member that was standing in the door between the classroom and ramp had then walked into the classroom. A few seconds later a child came in and said, “You forgot me outside”. Based on the information gathered from the self reported incident report and interview conducted with staff. It was determined that a child was left without the supervision of a teacher which poses a health and safety risk to children in care. Continue to page 2.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CATALYST KIDS-SYCAMORE
FACILITY NUMBER: 304270320
VISIT DATE: 05/03/2024
NARRATIVE
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Based on LPAs observations, records review, and interview the following Type A violation was observed and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 101229(a)(1) Responsibility for Providing Care and Supervision. See attached LIC809D.

This report cites Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

Exit interview conducted with Center Manager Nury Balmaceda. A copy of the Appeal Rights (LIC 9058 FAS 01/16) was given and explained. Center Manager’s signature on this form acknowledges receipt of the report (LIC 809). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/03/2024 02:51 PM - It Cannot Be Edited


Created By: Karen Navar On 05/03/2024 at 01:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CATALYST KIDS-SYCAMORE
FACILITY NUMBER: 304270320

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/03/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision.(a)The licensee shall provide care and supervision as necessary...(1)No child(ren) shall be left without the supervision of a teacher at any time,The licensee did not meet this requirement:

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Staff meeting was conducted on 4/15/2024 regarding supervsion during transiton times.
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Based on observation,record review, and interview. Staff left a child outside without supervsion from a teacher.
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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:Judy Hanson
LICENSING EVALUATOR NAME:Karen Navar
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024


LIC809 (FAS) - (06/04)
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