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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371096
Report Date: 06/25/2024
Date Signed: 06/25/2024 01:11:48 PM

Document Has Been Signed on 06/25/2024 01:11 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-ESTOCKFACILITY NUMBER:
304371096
ADMINISTRATOR/
DIRECTOR:		YANDIRA GARCIAFACILITY TYPE:
840
ADDRESS:14741 NORTH B. STREETTELEPHONE:
(714) 669-1320
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 202TOTAL ENROLLED CHILDREN: 32CENSUS: 15DATE:
06/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Site Supervisor-Nury BalmacedaTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
NARRATIVE
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On 6/25/2024 at 11:15AM Licensing Program Analyst (LPA) K.Navar conducted an unannounced Case Management Unusual Incident visit. Upon arrival, the LPA met with Site Supervisor Nury Balmaceda and discussed the unusual incident. The census at the time of the of visit was 15 children supervised by 3 staff during playground time.

A review of the Facility Personnel Report Summary shows all facility staff or individuals who require caregiver background checks have received a criminal record clearance and a child abuse index clearance or an exemption clearance.

The Department received an incident report on 5/16/2024 stating that on 5/15/24 Child #1 (C1) was picked up by an authorized representative and taken to the afternoon school program. When parent guardian arrived at facility to pick up C1 staff realized C1 was not with the group. Parent Guardian then went to after-school program and picked up C1. Teacher witnessed parent guardian pick up C1.

On 6/25/2024, the LPA interviewed 1 staff (S1). S1 stated that staff used a walkie talkie to communicate that C1 was leaving the facility and staff did not sign child out. A type B citation will be issued as this poses a health and safety risk to children in care. A person who removes the child from the center during the day and returns the child to the center the same day, shall sign the child in/out.

LPA obtained and reviewed the following documents. A copy of sign in and out sheet, roster, copy of procedure for sign in an out, C1’s consent form for after school program.

Based on the LPA’s observations, interviews, and records reviews, the following deficiency of Title 22 Division 12 was cited: 101229.1(c) Sign In and Sign Out (SEE LIC809D ATTACHED)

Continue to page 2.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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-ESTOCK
FACILITY NUMBER: 304371096
VISIT DATE: 06/25/2024
NARRATIVE
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LPA K.Navar informed Site Supervisor Nury Balmaceda that this licensing report dated 6/25/24 documents one “Type B” citation. An exit interview was conducted and The Notice of Site Visit was posted during the visit. The Site Supervisor 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. The Site Supervisor was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First-level appeals should be sent to the regional manager to the address listed above.

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

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/25/2024 01:11 PM - It Cannot Be Edited


Created By: Karen Navar On 06/25/2024 at 12:32 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-ESTOCK
FACILITY NUMBER: 304371096

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/25/2024
Section Cited
CCR
101229.1(c)

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101229.1Sign In and Sign Out (c) A person who removes the child from the center during the day, and returns the child to the center the same day, shall sign the child in/out. This requirement was not met as evidenced by:


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Conducted a staff meeting regarding sign in and out procedure, supervision policy, name to face, transition log, and provide a a copy of training to LPA with staff signatures.
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Intervivew and records review. Staff/authorized represenative did not sign child out child. This poses a health, safety and personal rights risk to the 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:Judy Hanson
LICENSING EVALUATOR NAME:Karen Navar
LICENSING EVALUATOR SIGNATURE:
DATE: 06/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/25/2024


LIC809 (FAS) - (06/04)
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