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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393604765
Report Date: 10/31/2024
Date Signed: 10/31/2024 12:07:27 PM

Document Has Been Signed on 10/31/2024 12:07 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CATALYST KIDS - JACOBSONFACILITY NUMBER:
393604765
ADMINISTRATOR/
DIRECTOR:		SERRANO, ANDIANAFACILITY TYPE:
840
ADDRESS:1750 KAVANAGH STREETTELEPHONE:
(209) 832-8799
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY: 70TOTAL ENROLLED CHILDREN: 58CENSUS: 0DATE:
10/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Lee McCowanTIME VISIT/
INSPECTION COMPLETED:
12:01 PM
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On October 31, 2024, Licensing Program Analyst (LPA) Stacey Williams met with Center Manager, Lee McCowan . There were no children present during the inspection.

LPA conducted interviews pertaining to the incident report submitted to Community Care Licensing on October 24, 2024.

Exit interview conducted and report was reviewed with Center Manager, Lee McCowan. 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.
Bettina EngelmanTELEPHONE: (916) 263-5820
Stacey WilliamsTELEPHONE: (916) 216-7797
DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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