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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343604805
Report Date: 05/10/2023
Date Signed: 05/10/2023 09:51:33 AM


Document Has Been Signed on 05/10/2023 09:51 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:CATALYST KIDS - PLEASANT GROVEFACILITY NUMBER:
343604805
ADMINISTRATOR:TYDINGCO, JENNIFERFACILITY TYPE:
840
ADDRESS:10160 PLEASANT GROVE SCHOOL RDTELEPHONE:
(916) 557-4401
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:70CENSUS: 0DATE:
05/10/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jennifer TydingcoTIME COMPLETED:
10:30 AM
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Application Specialist (AS) Alecia Sifuentes and Licensing Program Analyst (LPA) Jennie Tedlos met with Center Manager Nancy Torres Acevedo and Site Supervisor Jennifer Tydingco for the purpose of a case management inspection. Licensee requests a change of capacity to serve 35 school-age children from kindergarten and above. The facility is located at Pleasant Grove Elementary School and the program operates Monday through Friday from 6:30 a.m. to 6:00 p.m. AS received the elementary school’s annual passing fire inspection report on 5/5/2023.

A health and safety inspection was conducted in all areas accessible to children. Site Supervisor stated that the school-age program still occupies room 1 of the portable. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, AS did not take measurements. The children will use the school’s restrooms, and there is a separate private restroom for staff.

Site Supervisor 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.

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.

Exit interview conducted and report was reviewed with the Site Supervisor Jennifer Tydingco.

Effective today, 5/10/2023, AS will approve the change of capacity for 35 school-age children.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023
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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