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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620610
Report Date: 08/17/2021
Date Signed: 08/17/2021 04:19:28 PM

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 - SIERRAFACILITY NUMBER:
313620610
ADMINISTRATOR:FARREN, JUNEFACILITY TYPE:
840
ADDRESS:6811 CAMBORNE WAYTELEPHONE:
(916) 788-7141
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:60CENSUS: 25DATE:
08/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Susan TuckerTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Amanda Blesi and Katrina Owens made an unannounced case management inspection to address an unusual incident that occurred on 8/6/2021. LPA's met with Director, Susie Tucker, and Stephanie Martinez center manager A risk assessment for COVID-19 was performed prior to entering the facility. At approximately 1:30p.m., LPAs observed 25 school age children supervised by four staff members. During today's inspection, interviews were conducted. Further information is needed at this time.

No deficiencies were cited during today's inspection.

Notice of site visit provided.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
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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