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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370115
Report Date: 04/05/2024
Date Signed: 04/25/2024 02:07:16 PM

Document Has Been Signed on 04/25/2024 02:07 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-HICKS CANYONFACILITY NUMBER:
304370115
ADMINISTRATOR/
DIRECTOR:		RAIBON, KRISTENFACILITY TYPE:
840
ADDRESS:3817 VIEW PARKTELEPHONE:
(714) 544-3492
CITY:IRVINESTATE: CAZIP CODE:
92602
CAPACITY: 140TOTAL ENROLLED CHILDREN: 57CENSUS: 0DATE:
04/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Tim Bongco TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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This report has been amended.
Licensing Program Analyst (LPA) Navar conducted an on-site visit for the purpose of a Case Management Incident on 04/05/2024 LPA toured the facility with facility representative Tim Bongco. Census was taken in individual classrooms, there were 0 school-age children present upon arrival and 4 staff. Today's Case Management visit is being conducted in response to a self reported incident, reported to the OC CCL office on 03/27/2024, detailing a child's personal rights were violated.

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the visit, LPA reviewed the Incident Report with facility representative as well as the response of the facility. LPA spoke with 3 staff (S2-S4) who stated they were not in the room and 1 staff (S5) who stated they were off work for the week. All staff present at time of visit stated they do not have information that could pertain to the self-reported incident. LPA conducted 2 staff (S1 and S6) phone interviews. S1 stated that the personal rights incident was self reported by the staff member who was involved in the incident, and that the teacher is on paid administrative leave. S2 stated that they did not hear of the personal rights incident until the following day. From the information LPA gathered during this visit and staff interviews, LPA determined that the facility staff failed to ensure that each child is accorded with personal rights, and this is a Title 22 violation.


Therefore, in the areas that were inspected, one Type A deficiency was observed of the California Code of Regulations, Title 22, Division 12 Section 101223 Personal Rights. See attached LIC809D.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2024
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-HICKS CANYON
FACILITY NUMBER: 304370115
VISIT DATE: 04/05/2024
NARRATIVE
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LPA Navar informed facility representative, that this report dated 04/05/2024 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

LPA Navar also informed the facility representative to provide a copy of this licensing report dated 04/04/2024, that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted. The Notice of Site Visit was posted for no less than 30 consecutive days. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.



End of Report
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/29/2024 10:24 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/17/2024 11:38 AM


Created By: Karen Navar On 04/05/2024 at 02:58 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CATALYST KIDS-HICKS CANYON
FACILITY NUMBER: 304370115

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/05/2024
Section Cited
CCR
101223

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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse...
This requirement is not met as evidence by:
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Review children personal rights disucss escalation techniques and mediation techniques. Site supervisor stated he will email the agenda with meeting notes and each staff signature of acknowledgement.
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 A self-reported incident reported to the CCL office on 03/27/2024 reported a childs personal rights were being violated by a staff grabbing both wrist of a child in a rough manner.
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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: 04/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2024


LIC809 (FAS) - (06/04)
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