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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 090313184
Report Date: 06/16/2022
Date Signed: 06/16/2022 04:30:03 PM


Document Has Been Signed on 06/16/2022 04:30 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:CATALYST KIDS - SOUTH LAKE TAHOEFACILITY NUMBER:
090313184
ADMINISTRATOR:HUGHES,ALEXISFACILITY TYPE:
840
ADDRESS:3441 SPRUCE AVENUETELEPHONE:
(530) 541-5887
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY:39CENSUS: 12DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Caitlin MoranTIME COMPLETED:
04:40 PM
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At 10:20 a.m. on Thursday, June 16th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Program Lead, Caitlin Moran, for the purpose of an unannounced required 1 year inspection. A COVID-19 risk assessment was conducted. Operating hours of the facility are from 7:00 a.m.-5:30 p.m., seven days a week. Facility is currently closed on weekends. Children arrived to the facility after 3:30 p.m. At 4:10 p.m., LPA observed a census of 12 children supervised by 1 staff.

All individuals subject to criminal background review have obtained criminal record clearance. Program Lead was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA toured all activity and classroom spaces, restrooms, food service, and outdoor play areas. No children in care require medications. Program Lead stated that there are no poisons at the facility. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition, free of hazards. LPA observed outdoor playground area of the facility. The areas around or under climbing equipment are cushioned with wood chips to absorb a fall. Toileting facilities are in safe, sanitary, and operating condition. Toilets have stall doors to provide privacy. Facility provides PM snack. Menus were posted in the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting lids. Drinking water was readily

Report continues on 809-C.

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: CATALYST KIDS - SOUTH LAKE TAHOE
FACILITY NUMBER: 090313184
VISIT DATE: 06/16/2022
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available to children both indoors and outdoors via pitcher and cups. Facility uses an online application for sign in and sign out. There are no firearms nor bodies of water on the premises. LPA observed a functional carbon monoxide detector.

Staff files were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification. LPA observed immunization records and documentation of the educational background, training, and/or experience and AB 1207 Mandated Reporter training certificates.

Children's records were reviewed. Each child's file contained an emergency card, consent for emergency medical treatment and notifications of children’s and parent’s rights.

This facility does not provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.

The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

A CARE Tool staff interview was conducted with the Program Lead, Caitlin Moran.

During an unrelated inspection, LPA came to learn the the school age program is frequently out of ratio due to a staffing shortage. It was stated that there are times when more than 14 children are supervised by 1 staff. LPA observed ratio sheet with a staff to child ratio of more than 14 children to 1 staff for the week of May 30th-June3rd.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

report continued on 809-C.

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: CATALYST KIDS - SOUTH LAKE TAHOE
FACILITY NUMBER: 090313184
VISIT DATE: 06/16/2022
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Title 22 deficiencies are cited on the subsequent pages of this report. Program Lead acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided. Program Lead's signature on this report acknowledges receipt of these rights. This report was reviewed with the Program Lead, Caitlin Moran. An exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/16/2022 04:30 PM - 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: CATALYST KIDS - SOUTH LAKE TAHOE
FACILITY NUMBER: 090313184

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101516.5(b)(1)
(1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above, as it was learned that a teacher working alone has supervised more than 14 children, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2022
Plan of Correction
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4
A follow up inspection will be conducted to clear the citation.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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