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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343600618
Report Date: 01/04/2024
Date Signed: 01/04/2024 12:22:28 PM


Document Has Been Signed on 01/04/2024 12:22 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:CATALYST KIDS - NORTH COUNTRYFACILITY NUMBER:
343600618
ADMINISTRATOR:MITCHELL, KRYSTLEFACILITY TYPE:
840
ADDRESS:3901 LITTLE ROCK DRIVETELEPHONE:
(916) 332-5185
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:99CENSUS: 23DATE:
01/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Krystle MitchellTIME COMPLETED:
12:50 PM
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On January 4, 2024, Licensing Program Analyst (LPA) Michelle Perez, made an unannounced visit for the purpose of a case management, unusual incident report.

Upon arrival, LPA observed 11 of the school-aged children supervised by one (1) teacher, inside the classroom and the remaining children were supervised by two (2) additional teachers in a separate classroom. The Center Manager was also present.

During the visit, LPA spoke to a couple of children, regarding the incident that occurred when a child was playing soccer, and became injured. LPA also spoke to the center manager, to find further information about the incident. LPA found that a child had fallen, while playing soccer, and utilized their hand to brace themselves to avoid injury. Upon falling the child's wrist was injured. The child and the remaining children, stopped playing soccer and came into the classroom shortly after.

LPA found that those children who played soccer with the injured child, explained that the child did not cry, and only indicated that their wrist hurt. LPA also found there were no outwards signs of an injury, no swelling nor was the child crying and that the child's hand was inspected and no signs of injury were found. LPA found through interviews with other children, that the child came inside the classroom, and was acting normal, but did not use their hand to do anything. Further, LPA found through an interview with the center manager, the child did not indicate they wanted to have a guardian called. When staff asked why the child had their hands inside their sleeves, the child responded in a joking manner "I broke my hand." Staff responded with "really?" and proceeded to inspect the hand, while the child said, "you know kids," in a joking manner and laughed with friends.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle PerezTELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CATALYST KIDS - NORTH COUNTRY
FACILITY NUMBER: 343600618
VISIT DATE: 01/04/2024
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LPA also found that when the child was picked up from the facility, the guardian asked the child if they had pain, after learning they fell, and the child indicated they did. Guardian, explained to center manager, that they were baffled the child showed no outward signs of pain and the hand looked normal. Upon visiting the doctor's, it was confirmed the child did break their hand.

Center manager spoke to the guardian in the evening, who indicated the child still had no pain and did not want any medication. center manager spoke to the child on the phone and explained that the facility would have contacted the guardian, had the child indicated there was pain or a desire to speak to the guardian.

Facility understands protocol, and reports unusual incident reports to guardians often, and to licensing when medical attention is sought, if a child has been injured, as well as inspects children for injury when an incident occurs.

LPA did not find evidence of the facility not inspecting the child for injury after the fall. LPA found the staff spoke to the child about the fall to find if the child sustained an injury and could not find any evidence of injury.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle PerezTELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC809 (FAS) - (06/04)
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