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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620610
Report Date: 01/13/2023
Date Signed: 01/17/2023 09:03:32 AM


Document Has Been Signed on 01/17/2023 09:03 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:CATALYST KIDS - SIERRAFACILITY NUMBER:
313620610
ADMINISTRATOR:TUCKER, SUSANFACILITY TYPE:
840
ADDRESS:6811 CAMBORNE WAYTELEPHONE:
(916) 788-7141
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:60CENSUS: 0DATE:
01/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Deepa Deva (teacher)TIME COMPLETED:
02:00 PM
NARRATIVE
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On January 13, 2023, at approximately 12:00 PM, LPA Amanda Blesi met with teachers Deepa Deva and Pat Saboury for a case management inspection visit on this date to discuss the unusual incident report (UIR) that the program phoned into the Licensing office on 1/3/23, for an incident that occurred on the same date. Center Manager Krisite Brantley, arrived later during the inspection. There were no children present upon arrival and LPA was informed children usually begin to arrive around 2:45 PM.

LPA spoke with staff today (S1 and S2) who state they have a six year old child (C1) who has been able to exit the facility three times while in care. On 12/29/22, S1 was with a group of children at the bathroom when she observed C1 on the elementary school campus heading towards the bathroom. Later the same day, C1 again exited the facility and started running up the street while S2 chased the child past the cafeteria to the upper playground. On 1/3/23, C1 again exited the the facility and traveled about a mile down the street while staff followed close behind encouraging the child to return to the facility. LPA determined the facility failed to provide a safe environment for C1 resulting in the child leaving the facility on at least three occasions.

See LIC 809D for Title 22 deficiency cited on this date. Appeal Rights provided.

LPA Blesi informed facility representative Krisite Brantley that this report dated 1/13/23 document(s) one 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 Blesi informed the facility representative to provide a copy of this licensing report dated 1/13/23 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 Kristie Brantley.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
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 - SIERRA
FACILITY NUMBER: 313620610
VISIT DATE: 01/13/2023
NARRATIVE
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SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/17/2023 09:03 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: CATALYST KIDS - SIERRA
FACILITY NUMBER: 313620610

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
01/16/2023
Section Cited

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PERSONAL RIGHTS: The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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To correct the deficiency, a written plan of correction shall be sent to LPA by due date of 1/16/23.
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This requirement was not met when the facility failed to prevent a child (C1) from leaving the facility. A child was able to walk out the front door of the facility and travel down the street while staff followed trying to get the child to return to the facility.
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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: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
LIC809 (FAS) - (06/04)
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