304370213-1-30-2023-06-CC-SGUZ-CNKQN3-20230130111828

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370213
Report Date: 01/30/2023
Date Signed: 01/30/2023 11:18:49 AM

Document Has Been Signed on 01/30/2023 11:18 AM - 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-TRIDENT		FACILITY NUMBER:	304370213
ADMINISTRATOR:	PHILLIPS, DEBBIE		FACILITY TYPE:	850
ADDRESS:	1800 WEST BALL ROAD		TELEPHONE:	(714) 999-5632
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY: 41	TOTAL ENROLLED CHILDREN: 16	CENSUS: 11	DATE:	01/30/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:41 AM
MET WITH:	Maria Baes, lead		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 01/30/2023 at 8:41 AM Licensing Program Analyst, Stella Gutierrez made an unannounced visit for the purpose of conducting an investigation regarding a self reported incident that took place on 01/27/2023. LPA was met by Maria Baes, Lead Teacher and stand in for director who was explained the reason for today's visit. LPA toured the facility inside and out. The direct,Magail Mesina showed up during the tour. Upon arrival LPA observed 11 children and 04 Staff providing care. A review of the Facility Personnel Report Summary conducted on 01/30/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. There was a self reported incident made to CCLD on 01/27/2023 that Child #1 was observed by Staff #2 outside on the pre-school playground unattended. During today's inspection On 01/30/2023 LPA interviewed 03 staff. It was revealed based on interviews and observation that on 01/27/2023 during the playground transition to indoors that Child #1 was left outside with adult supervision. On 01/30/2023 Staff #2 stated that while on the playground at 10:30 AM is was observed that child #1 was on the play structure alone. Staff #2 stated that they looked over the gate to see if there was another staff with Child #3 and Staff #3 stated that there was not staff and that classroom #22 door was closed as child #1 was outside alone with no adult supervision. Staff #1 who assist in Classroom #22 stated that they observed child #1 on the play structure during transition and Staff #3 (not present during LPAs visit today) asked Staff #1 to go inside and assist with washing hands while Staff #3 calls children in by their name. Page 1 of 2

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

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-TRIDENT	FACILITY NUMBER: 304370213
	VISIT DATE: 01/30/2023

NARRATIVE

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On 01/30/2023 Staff #1 stated that a head count was not done once all the children entered classroom #22 which resulted a lack of supervision to ensure the safety of all children transitioning inside from outside was complete. Staff #1 also stated that it was only 5-10 seconds when Staff #3 realized that Child #1 was not in the classroom as Staff #3 entered with the child. On 01/30/2023 The director stated that training's are done each month on supervision or personal rights. The training consist of a module training. There is no training on head counts as the facility just bases the count on matching the name to the face of the children.

On 01/30/2023 LPA reviewed attendance to be 14 children and 2 staff present on 01/27/2023 when normally there are 3-4 staff daily for classroom #22. It was determined that the facility within ratio and capacity in accordance to title 22 limitations and on the facility licensee. The playground is about 8-10 feet away from the door entrance of classroom #22.

Based on LPAs observation and statements, it was revealed that child #1 was left outside on the playground alone on 01/27/2023 without any adult supervision. The child was left unattended for about 5-10 seconds as the Staff #3 did realize child #1 was not present in the classroom. During that 5-10 seconds Staff #2 brought the child #1 back into the classroom. The following violation for Responsibility for providing care and supervision was revealed today and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, 101229 (a)(1) . Please see the attached LIC 809D.

Exit interview conducted and report was reviewed with the director, Magail Mesina. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/30/2023 11:18 AM - It Cannot Be Edited

Created By: Stella Gutierrez On 01/30/2023 at 11:06 AM

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-TRIDENT	FACILITY NUMBER: 304370213
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/30/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/03/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time.... Supervision shall include visual observation.	1 2 3 4 5 6 7	The director agrees that an effective head count procedure training should be provided to all staff. The director stated that the training agenda and role sheet will be completed and emailed to LPA via email to stella.gutierrez@dss.ca.gov by 02/03/2023 before 6:00 PM.
	8 9 10 11 12 13 14	This regulation was not met as evidence by interviews conducted that child #1 was left outside for at least 10-15 seconds without a staff present. Based on the circumstances of time left and distance a type B deficiency it being cited. This is a potential risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Stella Gutierrez

LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

LIC809 (FAS) - (06/04)

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