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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620609
Report Date: 08/15/2022
Date Signed: 08/15/2022 03:29:01 PM


Document Has Been Signed on 08/15/2022 03:29 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 - ANTELOPE CREEKFACILITY NUMBER:
313620609
ADMINISTRATOR:DONNOLLEY, ALEXISFACILITY TYPE:
840
ADDRESS:6185 SPRINGVIEW DRTELEPHONE:
(916) 778-3082
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:50CENSUS: 22DATE:
08/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jailean O'Neal and Jessica AnayaTIME COMPLETED:
03:45 PM
NARRATIVE
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LPA Amanda Blesi conducted an unannounced Case Management visit in regards to a received Unusual Incident Report (UIR). LPA met with Jailean O'Neal and Jessica Anaya. Alexis Donnolly was not present today. Upon arrival there were 21 school age children supervised by 3 staff.

An incident report was received in the Licensing office on 8/4/22 which stated that on 7/27/22, three children ages 9, 7 and 6 exited the facility through an unlocked gate and took off down the street. Children on the playground immediately notified teacher Jailean that the children were out of the gate and Jailean ran after the children calling for them to stop. Jailean states she ran down the sidewalk after the children; keeping them in her sight. The director, Alexis Donnally was out at the store getting more milk at the time and was notified of the incident. As she returned to the center she saw the children traveling down the sidewalk and pulled over to stop them. The three children and teacher Jailean returned to the center in the director's vehicle.

Title 22 Deficiency has been cited on the attached LIC 809-D. LPA Amanda Blesi informed Jessica Analya that this report dated 8/15/22 document(s) 0ne Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Amanda Blesi informed the facility representative Jessica Anaya to provide a copy of this licensing report dated 8/15/22 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the facility representative Jessica Anaya. A notice of site visit was given and must remain posted for 30 days.Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A $500.00 Civil Penalty is assessed for Zero Tolerance. (see attached LIC 421)
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2022
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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Document Has Been Signed on 08/15/2022 03:29 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 - ANTELOPE CREEK
FACILITY NUMBER: 313620609

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/16/2022
Section Cited

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Responsibility for Providing Care and Supervision
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

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This requirement was not met as evidence by: LPA learned that three children escaped through an unlocked gate on the playground and ran down the sidewalk. Staff were initially unaware that the children had escaped through the gate and were told by the other children on the playground. This is an immediate risk to the health and safety of children in care. This is a zero tolerance violation and civil penalties in the amount of $500.00 are assessed
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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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2022
LIC809 (FAS) - (06/04)
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