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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621948
Report Date: 05/03/2024
Date Signed: 05/03/2024 02:25:01 PM


Document Has Been Signed on 05/03/2024 02:25 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 - ZEHNDER RANCHFACILITY NUMBER:
343621948
ADMINISTRATOR:MCCLELLAND, LISAFACILITY TYPE:
840
ADDRESS:9880 DENALI CIRCLETELEPHONE:
(916) 286-7865
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:70CENSUS: DATE:
05/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lisa McClellandTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA’s) Corina Beckby and Stacey Williams met with Site Supervisor, Lisa McClelland, to follow up on the Unusual Incident Report (UIR) emailed to Community Care Licensing on April 23, 2024. During today's inspection LPA’s toured the facility, conducted interviews with staff and obtained information pertinent to the incident.

The facility reported the UIR to Community Care Licensing within 24hrs and submitted a written UIR within 7 days.

The center self-reported that on 04/17/24, at approximately 5:00 pm, a student ran out of the facility. Site Supervisor followed the student but could not keep up with the student. The facility called 911 and both parents. Elk Grove School District Police Department found the student at a local park approximately .4 miles from the facility. Student was picked up by parent at the park.

Based on the interview and information obtained, a Title 22 Deficiency has been issued on the attached LIC 809-D. The facility was informed that this report dated 05/03/2024 documents one Type A citation which shall be posted for 30 consecutive days. The facility shall also provide a copy of this licensing report 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. Because the citation involved an absence of supervision, an immediate civil

Continued on LIC809-C...

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024
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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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 - ZEHNDER RANCH
FACILITY NUMBER: 343621948
VISIT DATE: 05/03/2024
NARRATIVE
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penalty of $500 has been issued. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Facility has been provided with appeal rights.

Facility evaluation report was reviewed and discussed with Site Supervisor, Lisa McClelland. Exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/03/2024 02:25 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 - ZEHNDER RANCH
FACILITY NUMBER: 343621948

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/06/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision... (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by:
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LPA’s provided Technical Support Program brochure, websites for California MAP to Inclusion and Supervision in Center video on department website. Site Director
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Based on interview, the facility did not comply with the section cited above, student ran out of the facility which resulted in absence of supervison, which poses an immediate health, safety or personal rights risk to persons in care.
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will pick up student from school and will stay in ratio. Site Director had meeting with staff regarding supervision and will send signed training materials and roster. SD will reasses the room for safety.

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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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024
LIC809 (FAS) - (06/04)
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