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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841029
Report Date: 10/04/2022
Date Signed: 10/04/2022 11:30:50 AM


Document Has Been Signed on 10/04/2022 11:30 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, 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:144CENSUS: 90DATE:
10/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rachel Smith, Center ManagerTIME COMPLETED:
11:45 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 October 4, 2022 at 10:00AM, Licensing Program Analyst (LPA) Alaina Wilburn conducted a case management visit in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on September 13, 2022. It indicates that Staff #1 (S1) saw Room #6 walk through the playground gate and enter their classroom. S1 noticed the gate to the playground open and walked over to close it. At the gate, S1 saw C1 on the playground. Room #6 teachers had already transitioned their 16 children into their classroom from the playground and C1 was left unattended. The incident occurred on September 6, 2022, child #1 and staff involved are identified on the LIC811 (Confidential Names)”.

Facility records were reviewed and copies received. LPA interviewed Center Manager in regards to incident, and she provided LPA a copy of statements from all Staff who were present that day. Based on the information gathered, facility failed to comply with Care and Supervision per regulation section 101229(a)(1) Care and Supervision, which specifies: No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).

If a civil penalty has been assessed during this inspection, payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. You will receive an invoice in the mail. Do not send money until you receive your invoice. Do not send cash.

See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Division. Chapter 12.

An exit interview was conducted, and this report was reviewed with the Center Manager Rachel Smith. Appeal rights were discussed and provided during the exit interview.



A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022
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 10/04/2022 11:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: CATALYST KIDS - MENIFEE
FACILITY NUMBER: 334841029

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/05/2022
Section Cited

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... Supervision shall include visual observation. The requirement is not met as evidenced by:
8
9
10
11
12
13
14
The facility submitted an Unusual Incident Report dated September 6, 2022, which reported that Staff #1 (S1) observed Child #1 (C1) was left unattended on the playground, after C1's classroom returned indoors, which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
children and teachers, Also, staff were advised if they are having challenges they can use the walkie talkie to call for assistance. Documentation and sign in sheets provided to LPA during today's visit. A zero tolerance civil penalty will be issued and Mrs. Smith will ensure the LIC 9224s are completed within 24 hours.

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: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2