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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393604766
Report Date: 04/03/2024
Date Signed: 04/03/2024 02:17:26 PM


Document Has Been Signed on 04/03/2024 02:17 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 - WANDA HIRSCHFACILITY NUMBER:
393604766
ADMINISTRATOR:RODRIGUEZ, MARIAFACILITY TYPE:
840
ADDRESS:1280 DOVE STREETTELEPHONE:
(209) 836-0977
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:70CENSUS: 0DATE:
04/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Maria Rodriguez TIME COMPLETED:
02:35 PM
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On April 3 , 2024, Licensing Program Analyst (LPA) Stacey Williams conducted a case management inspection and met with Site Supervisor, Maria Rodriguez. LPA toured the facility with facility staff. There were no children present during the inspection.

LPA discussed an incident report that was submitted to Community Care Licensing on March 22, 2024 with facility staff.

Exit interview conducted and report was reviewed with the Site Supervisor, Maria Rodriguez. 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.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024
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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