<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841029
Report Date: 03/01/2024
Date Signed: 03/01/2024 02:00:16 PM

Document Has Been Signed on 03/01/2024 02:00 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CATALYST KIDS - MENIFEEFACILITY NUMBER:
334841029
ADMINISTRATOR:RACHEL M SMITHFACILITY TYPE:
850
ADDRESS:25625 BRIGGS ROADTELEPHONE:
(951) 928-4000
CITY:MENIFEESTATE: CAZIP CODE:
92585
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 75DATE:
03/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:Rachel Smith, DirectorTIME COMPLETED:
02:00 PM
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
Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced Case Management inspection to follow-up on an Unusual Incident Report (UIR) submitted to Community Care Licensing CCL on December 21, 2023. LPA met with Rachel Smith (Director) and toured the facility. LPA interviewed the director and three staff members during this inspection.

On December 21, 2023, CCL received information via UIR that a child (C1) had their finger caught in a door that later required stitches. Interviews with staff and record review revealed that; although, there was sufficient staffing in the room at the time of incident, there was a lack of supervision which resulted in C1 sustaining an injury that required immediate medical treatment. The incident was reported to CCL and documentation observed in the injured child’s file and parents were notified in a timely manner.

Based on information gathered, the CCC was given a Type A deficiency.

An exit interview was held with Director Rachel Smith. A copy of this report was issued, along with copies of the LIC809D, Appeal Rights, LIC811 (confidential names list) along with a Notice of Site visit. This report shall be public record for three years.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024
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 2
Document Has Been Signed on 03/01/2024 02:00 PM - It Cannot Be Edited


Created By: Jesse Gardner On 03/01/2024 at 01:22 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: CATALYST KIDS - MENIFEE
FACILITY NUMBER: 334841029

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
03/04/2024
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not being met as evidenced by:
1
2
3
4
5
6
7
Licensee states that they will conduct in-service training on the cited regulation and provide proof of such to LPA by POC date.
8
9
10
11
12
13
14
Based on staff interview, C1 was not afforded proper supervision to prevent C1's injury that required a hospital visit, and stitches to C1's finger. This poses an immediate health and safety risk to 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:Deborah Mullen
LICENSING EVALUATOR NAME:Jesse Gardner
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2