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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621304
Report Date: 06/07/2024
Date Signed: 06/12/2024 09:38:00 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/12/2024 09:38 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CATALYST KIDS - PLEASANT GROVEFACILITY NUMBER:
343621304
ADMINISTRATOR/
DIRECTOR:		TYDINGCO, JENNIFERFACILITY TYPE:
850
ADDRESS:10160 PLEASANT GROVE SCHOOL RDTELEPHONE:
(916) 686-1260
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 6DATE:
06/07/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Jennifer TydingcoTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
NARRATIVE
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On June 7, 2024 Licensing Program Analyst (LPA) Jennie Tedlos met with Director (D1), Jennifer Tydingco to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 5/30/24. Present were 6 children in care and 2 staff. LPA conducted interviews during today's visit.

On 5/22/24, an incident occurred where a staff member (S1) witnessed another staff member (S2) pour water over the head of a Child (C1) during water play without permission. The same day, S1 observed S2 use a personal water bottle to pour water on C1's head again without permission. S1 observed that C1 was upset and crying during both incidents. S1 reported the incident to Director (D1), Jennifer Tydingco on 5/24 when both S1 and D1 were present at the facility. After D1 was notified, the facility conducted an internal investigation and placed S2 on administrative leave and is being terminated as of today. D1 has stated to LPA that staff has since been retrained on reporting incidents to administration, mandated reporter duties, child rights, 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.

* This is an amended version of a report originally signed on 6/7/24. LPA mistakenly recorded the report's "Type of Visit" as "Annual/Random" instead of "Case Management -Incident".

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
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)
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Document Has Been Signed on 06/12/2024 09:38 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 06/07/2024 03:39 PM


Created By: Jennie Tedlos On 06/07/2024 at 10:36 AM
Link to Parent Document Below:
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 - PLEASANT GROVE
FACILITY NUMBER: 343621304

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

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101223 Personal Rights: (a) The licensee shall ensure that each child is accorded ...personal rights:...(3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature ...
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This regulation was not met as evidenced by: LPA learned that S2 poured water over the head of C1 twice in one day without permission from C1. Both times C1 was observed to be upset and crying.This poses an immediate risk to the health and safety of children in care.
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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.* This is an amended version of a report from 6/7/24. Report recorded as "Annual/Random" instead of "Case Management-Incident".

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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:Karyn Guerra
LICENSING EVALUATOR NAME:Jennie Tedlos
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)
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