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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561702673
Report Date: 04/24/2024
Date Signed: 04/24/2024 12:01:18 PM

Document Has Been Signed on 04/24/2024 12:01 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CATALYST KIDS- GREEN VALLEYFACILITY NUMBER:
561702673
ADMINISTRATOR/
DIRECTOR:		RACHEL CHAMPAGNEFACILITY TYPE:
850
ADDRESS:170 N. JUANITA AVE.TELEPHONE:
(805) 486-3557
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 29DATE:
04/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Amanda IzaguirreTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On April 24, 2024 at 11:45 AM, Licensing Program Analysts (LPAs) Aaliyah Zendejas and Veronica Diaz conducted a Case Management - Incident inspection at the above - mentioned facility to follow up on the report of an Unusual Incident Report (UIR) received by the department on 04/15/2024. LPAs met with Director Amanda Izaguirre to discuss the nature of the report and follow up..

LPAs conducted a tour of the facility with staff member, reviewed five staff files, C1 file and interviewed staff. LPAs talked to director and master teacher regarding the incident report that was received by the regional office (RO).
The incident report was reported to CPS and has a report number attached. Following the incident, C1 was taken out for health issues for a week but has returned to care as of 04/23/2024.
During today's inspection, no deficiencies were cited.
Exit interview and review of report was conducted with Director Amanda Izaguirre.
A notice of site visit was provided and must remain posted for the next 30 days.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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