CATALYST KIDS-SPRINGBROOK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Mila Quinto conducted a case management inspection in response to a self-reported incident on June 28, 2021. LPA and staff, Justine Hernandez toured the facility inside and outside and the floor and yard plan were verified. Census was taken and the overall census observed were 2 staff and 10 school age children. Director, Margarita Villagomez arrived at 10am. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. On 06/28/21 the facility self-reported that on 6/23/21 at 4:40pm, the 2 staff were transitioning the children in care from the restroom back to the classroom. During this time, a parent arrived at 4:41pm to pick up child and notice the child was walking back from the restroom without supervision. A staff looked over towards the restroom and saw the child walking out from the restroom. LPA interviewed 3 staff members regarding the incident. Based on the information gathered through interviews and records, it was confirmed that child was left in the restroom without supervision for a period of 1 minute. Staff reports that it was an oversight that occurred during transitioning of the children. This poses an immediate health and safety risk to the children in care. The facility self-reported the incident on June 28, 2021 regarding the incident that took place on June 23, 2021. During the course of the investigation, LPA interviewed director regarding the reporting requirements. The director is aware of the reporting requirements within 24 hours on unusual incident. However, during this timeline, director discussed with the parents and the program director prior to contacting licensing. SUPERVISORS NAME: Rina Lopez LICENSING EVALUATOR NAME: Mila Quinto LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2021 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 4 FACILITY NAME: CATALYST KIDS-SPRINGBROOKFACILITY NUMBER: 304371447 VISIT DATE: 07/09/2021 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 26 27 28 29 30 31 32Page 2 California Code of Regulations, Title 22, Division 12 Section 101229(a)(1), Responsibility for Providing Care and Supervision is being cited on the attached LIC 809D. This report cites a Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file; 101212(a) Reporting Requirements is also being cited on the attached LIC 809D. An exit interview was completed with director. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. If the facility receives a Type A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00 Exit interview was conducted. Notice of Site Visit was posted during the visit. Coordinator was informed that the notice of site visit must be posted for 30 consecutive days. SUPERVISORS NAME: Rina Lopez LICENSING EVALUATOR NAME: Mila Quinto LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2021 FACILITY NAME: CATALYST KIDS-SPRINGBROOK FACILITY NUMBER: 304371447 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/09/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 07/09/2021 Section Cited CCR

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Mila Quinto conducted a case management inspection in response to a self-reported incident on June 28, 2021. LPA and staff, Justine Hernandez toured the facility inside and outside and the floor and yard plan were verified. Census was taken and the overall census observed were 2 staff and 10 school age children. Director, Margarita Villagomez arrived at 10am. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. On 06/28/21 the facility self-reported that on 6/23/21 at 4:40pm, the 2 staff were transitioning the children in care from the restroom back to the classroom. During this time, a parent arrived at 4:41pm to pick up child and notice the child was walking back from the restroom without supervision. A staff looked over towards the restroom and saw the child walking out from the restroom. LPA interviewed 3 staff members regarding the incident. Based on the information gathered through interviews and records, it was confirmed that child was left in the restroom without supervision for a period of 1 minute. Staff reports that it was an oversight that occurred during transitioning of the children. This poses an immediate health and safety risk to the children in care. The facility self-reported the incident on June 28, 2021 regarding the incident that took place on June 23, 2021. During the course of the investigation, LPA interviewed director regarding the reporting requirements. The director is aware of the reporting requirements within 24 hours on unusual incident. However, during this timeline, director discussed with the parents and the program director prior to contacting licensing. SUPERVISORS NAME: Rina Lopez LICENSING EVALUATOR NAME: Mila Quinto LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2021 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 4 FACILITY NAME: CATALYST KIDS-SPRINGBROOKFACILITY NUMBER: 304371447 VISIT DATE: 07/09/2021 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 26 27 28 29 30 31 32Page 2 California Code of Regulations, Title 22, Division 12 Section 101229(a)(1), Responsibility for Providing Care and Supervision is being cited on the attached LIC 809D. This report cites a Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file; 101212(a) Reporting Requirements is also being cited on the attached LIC 809D. An exit interview was completed with director. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. If the facility receives a Type A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00 Exit interview was conducted. Notice of Site Visit was posted during the visit. Coordinator was informed that the notice of site visit must be posted for 30 consecutive days. SUPERVISORS NAME: Rina Lopez LICENSING EVALUATOR NAME: Mila Quinto LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2021 FACILITY NAME: CATALYST KIDS-SPRINGBROOK FACILITY NUMBER: 304371447 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/09/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 07/09/2021 Section Cited CCR

Type A citation - immediate risk to health, safety, or personal rights

Type B citation - potential risk if not corrected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Mila Quinto conducted a case management inspection in response to a self-reported incident on June 28, 2021. LPA and staff, Justine Hernandez toured the facility inside and outside and the floor and yard plan were verified. Census was taken and the overall census observed were 2 staff and 10 school age children. Director, Margarita Villagomez arrived at 10am. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. On 06/28/21 the facility self-reported that on 6/23/21 at 4:40pm, the 2 staff were transitioning the children in care from the restroom back to the classroom. During this time, a parent arrived at 4:41pm to pick up child and notice the child was walking back from the restroom without supervision. A staff looked over towards the restroom and saw the child walking out from the restroom. LPA interviewed 3 staff members regarding the incident. Based on the information gathered through interviews and records, it was confirmed that child was left in the restroom without supervision for a period of 1 minute. Staff reports that it was an oversight that occurred during transitioning of the children. This poses an immediate health and safety risk to the children in care. The facility self-reported the incident on June 28, 2021 regarding the incident that took place on June 23, 2021. During the course of the investigation, LPA interviewed director regarding the reporting requirements. The director is aware of the reporting requirements within 24 hours on unusual incident. However, during this timeline, director discussed with the parents and the program director prior to contacting licensing. SUPERVISORS NAME: Rina Lopez LICENSING EVALUATOR NAME: Mila Quinto LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2021 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 4 FACILITY NAME: CATALYST KIDS-SPRINGBROOKFACILITY NUMBER: 304371447 VISIT DATE: 07/09/2021 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 26 27 28 29 30 31 32Page 2 California Code of Regulations, Title 22, Division 12 Section 101229(a)(1), Responsibility for Providing Care and Supervision is being cited on the attached LIC 809D. This report cites a Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file; 101212(a) Reporting Requirements is also being cited on the attached LIC 809D. An exit interview was completed with director. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. If the facility receives a Type A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00 Exit interview was conducted. Notice of Site Visit was posted during the visit. Coordinator was informed that the notice of site visit must be posted for 30 consecutive days. SUPERVISORS NAME: Rina Lopez LICENSING EVALUATOR NAME: Mila Quinto LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2021 FACILITY NAME: CATALYST KIDS-SPRINGBROOK FACILITY NUMBER: 304371447 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/09/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 07/09/2021 Section Cited CCR

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Mila Quinto conducted a case management inspection in response to a self-reported incident on June 28, 2021. LPA and staff, Justine Hernandez toured the facility inside and outside and the floor and yard plan were verified. Census was taken and the overall census observed were 2 staff and 10 school age children. Director, Margarita Villagomez arrived at 10am. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. On 06/28/21 the facility self-reported that on 6/23/21 at 4:40pm, the 2 staff were transitioning the children in care from the restroom back to the classroom. During this time, a parent arrived at 4:41pm to pick up child and notice the child was walking back from the restroom without supervision. A staff looked over towards the restroom and saw the child walking out from the restroom. LPA interviewed 3 staff members regarding the incident. Based on the information gathered through interviews and records, it was confirmed that child was left in the restroom without supervision for a period of 1 minute. Staff reports that it was an oversight that occurred during transitioning of the children. This poses an immediate health and safety risk to the children in care. The facility self-reported the incident on June 28, 2021 regarding the incident that took place on June 23, 2021. During the course of the investigation, LPA interviewed director regarding the reporting requirements. The director is aware of the reporting requirements within 24 hours on unusual incident. However, during this timeline, director discussed with the parents and the program director prior to contacting licensing. SUPERVISORS NAME: Rina Lopez LICENSING EVALUATOR NAME: Mila Quinto LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2021 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 4 FACILITY NAME: CATALYST KIDS-SPRINGBROOKFACILITY NUMBER: 304371447 VISIT DATE: 07/09/2021 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 26 27 28 29 30 31 32Page 2 California Code of Regulations, Title 22, Division 12 Section 101229(a)(1), Responsibility for Providing Care and Supervision is being cited on the attached LIC 809D. This report cites a Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file; 101212(a) Reporting Requirements is also being cited on the attached LIC 809D. An exit interview was completed with director. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. If the facility receives a Type A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00 Exit interview was conducted. Notice of Site Visit was posted during the visit. Coordinator was informed that the notice of site visit must be posted for 30 consecutive days. SUPERVISORS NAME: Rina Lopez LICENSING EVALUATOR NAME: Mila Quinto LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2021 FACILITY NAME: CATALYST KIDS-SPRINGBROOK FACILITY NUMBER: 304371447 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/09/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 07/09/2021 Section Cited CCR