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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561709946
Report Date: 01/14/2025
Date Signed: 01/14/2025 01:08:20 PM

Document Has Been Signed on 01/14/2025 01:08 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- MOUNDFACILITY NUMBER:
561709946
ADMINISTRATOR/
DIRECTOR:		DEBORAH DORFMANFACILITY TYPE:
840
ADDRESS:455 S. HILL RD.TELEPHONE:
(805) 650-8791
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 79TOTAL ENROLLED CHILDREN: 79CENSUS: 18DATE:
01/14/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:33 AM
MET WITH:Kalee PizaroTIME VISIT/
INSPECTION COMPLETED:
01:19 PM
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On 1/14/2025 Licensing Program Analyst (LPA) German Negrete made an unannounced visit for the purpose of conducting a Case Management - Incident inspection. LPA met with Center Director Kalee Pizaro and discussed the purpose of the inspection. During the case management inspection, LPA did a walk through of the Facility with site supervisor. At the time of the inspection LPA observed 18 children and 3 staff providing care and supervision.

On 12/18/2024, Site supervisor contacted Community Care Licensing (CCL) to self-report the following unusual incident : at approximately 3:15PM C1 was outside playing on the grass with other children. During outdoor play time, C1 tripped/slipped and hurt right palm(scraped) and the right thumb. S1 and S2 observed the child crying. S1 and S2 comforted C1. S2 observed C1's palm had a open cut on the bottom portion of the thumb. S1 and S2 took C1 inside and applied ice, washed the hand, and applied more ice. According S2, when the parent arrived to pick up C1, S2 notified the parent. C1 was taken to Ventura Orthopedics. According to Staff, C1 received a fracture, and C1 is currently wearing a brace on the right hand. Site Supervisor stated, parent did not provide a doctor's note.

The date the facility submitted a written Unusual Incident Report (LIC624) is currently being verified (see LIC812).

Continued on LIC809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CATALYST KIDS- MOUND
FACILITY NUMBER: 561709946
VISIT DATE: 01/14/2025
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Today LPA conducted staff interviews, LPA also reviewed records and children files(LIC857).

Also today LPA has requested a children's roster.

Due to insufficient information available at the time of the inspection, the departments(CCL) review of the 12/10/2024 incident is on going.

The report was read to Site Supervisor,

LIC857 and Notice of site visit was provided to Site Supervisor.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
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