<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343605598
Report Date: 06/07/2024
Date Signed: 06/07/2024 01:00:32 PM


Document Has Been Signed on 06/07/2024 01:00 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:CATALYST KIDS - RAYMOND CASEFACILITY NUMBER:
343605598
ADMINISTRATOR:AFYIA TYLERFACILITY TYPE:
840
ADDRESS:8565 SHASTA LILY DRIVETELEPHONE:
(916) 681-3355
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:106CENSUS: 2DATE:
06/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Afyia TylerTIME COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On June 7, 2024 Licensing Program Analyst (LPA) Jennie Tedlos met with Director (D1), Afyia Tyler to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 5/28/24. Present were 0 children in care. LPA conducted interviews during today's visit.

On 5/23/24, an incident occurred where several staff members witnessed a staff member (S1) and a child (C1) engaging in an argument. Staff members witnessed S1 yelling at C1 inappropriately which caused C1 to become upset and cry. The Director (D1) was notified of the incident the same day which lead to an internal investigation, placing S1 on administrative leave. S1 is being terminated as of today. D1 has stated to LPA that 1:1 meetings have been held with teachers about the situation and meetings are scheduled for the near future to discuss reporting incidents to administration, transitioning in the classroom, supervision, and strategies to create a safe environment for the children in care.

A deficiency is being cited based on LPA observation, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. A Type A violation regarding Personal Rights is hereby assessed.

Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files.



An exit interview was conducted and Plans of Correction were reviewed and developed with the Director. A copy of this report and appeal rights were discussed and left with Director. A notice of site visit was provided and posted by LPA and must remain posted for 30 days.
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: (916) 936-7763
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024
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


Document Has Been Signed on 06/07/2024 01:00 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: CATALYST KIDS - RAYMOND CASE
FACILITY NUMBER: 343605598

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/10/2024
Section Cited
CCR
101223(a)(1)

1
2
3
4
5
6
7
101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:(1) To be accorded dignity in his/her personal relationships with staff and other persons.

This regulation was not met as evidenced by:
1
2
3
4
5
6
7
The facility launched an internal investigation following the incident and has placed Staff 1 on administrative leave and will be terminated as of today. Staff trainings will be conducted including the following topics: reporting incidents, supervision, and creating a safe environment. In addition to the trainings, ...
8
9
10
11
12
13
14
LPA learned through a self reported Unusual Incident Report and interviews that an argument lead Staff 1 to inappropriately yell at Child 1. Child 1 was observed upset and crying following the situation. This poses an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14
 ...the facility's staff will watch the CDSS Community Care Licensing training video on personal rights. D1 will send LPA signatures from staff stating that they watched and understand the training video by the POC due date, 6/10/24.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: (916) 936-7763
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2