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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270425
Report Date: 03/28/2023
Date Signed: 03/28/2023 02:24:31 PM

Document Has Been Signed on 03/28/2023 02:24 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CATALYST KIDS-NELSONFACILITY NUMBER:
304270425
ADMINISTRATOR:MORENO, ERIKAFACILITY TYPE:
840
ADDRESS:14392 BROWNING AVENUETELEPHONE:
(714) 731-0111
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 0DATE:
03/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Andrea Castillo/Site SupervisorTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPAs) Mila Quinto and Aidee Nunez conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 3/22/2023. LPAs met with Site Supervisor Andrea Castillo. There were 3 staff and no children present at the time of the arrival.

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

On 3/22/2023, self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported a child sustained an injury from a hot soup spilling on Child 1 (C1) lap.

During today's inspection, LPA interviewed 3 staff members. All staff stated when warming up food for the children, the warmed food is placed on the cart to allow the food to cool off for approximately 5 minutes prior to serving to the children. According to Staff 1(S1), prior to snack time, S1 warmed the soup in the microwave for C1. S1 stated placed the hot soup on the table while it was hot and informed C1 to wait for S1. S1 admitted did not wait 5 minutes and placed the hot soup on the table infront of C1. Another child threw a ball and landed on the table and hit C1’s soup causing the soup to land on C1’s lap. Staff 2 (S2) stated heard C1 scream and quickly assisted C1 and witnessed C1’s lap was burnt. Staff 3 (S3) stated called C1’s parent right away. C1’s parent arrived at the facility to drop off an ointment and C1 stayed in the facility until the normal pick-up time.

On 3/27/23, LPA interviewed Parent 1 and stated C1 did not seek medical evaluation and have continued to apply ointment at home.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2023
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CATALYST KIDS-NELSON
FACILITY NUMBER: 304270425
VISIT DATE: 03/28/2023
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Based on LPA’s interviews conducted with 3 staff members, the following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101223(a)(2) Personal Rights. The deficiency is being cited on the attached 809D.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days. The facility representative was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The 'Notice of Site Visit' must be posted on or adjacent to the door. Failure to post Type A Reports for 30 days will result in a civil penalty of $100.00.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/28/2023 02:24 PM - It Cannot Be Edited


Created By: Mila Quinto On 03/28/2023 at 01:56 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-NELSON
FACILITY NUMBER: 304270425

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2023
Section Cited
CCR
101223(a)(2)

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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe... comfortable accommodations...
This requirement is not met as evidenced by:
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The Site Supervisor stated will no longer warm food for the children. Any hot food must be in thermos to keep the the food warm. Site Supervisor had a meeting with all staff and will provide an agenda of the meeting to LPA via email by due date.
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Based on interviews conducted with 3 staff members, staff did not ensure the temperature of the hot soup served to C1
This poses a potential safety risk to children in care.
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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:Patricia Magana
LICENSING EVALUATOR NAME:Mila Quinto
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023


LIC809 (FAS) - (06/04)
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