393605862-7-26-2023-53-CC-SWIS-CU4TJ2-20230726144539

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393605862
Report Date: 07/26/2023
Date Signed: 07/26/2023 02:45:44 PM

Document Has Been Signed on 07/26/2023 02:45 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 - JACOBSON		FACILITY NUMBER:	393605862
ADMINISTRATOR:	MALISSA MASTROPIERRO		FACILITY TYPE:	850
ADDRESS:	1750 KAVANAGH STREET		TELEPHONE:	(209) 832-8799
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	48	CENSUS: 11	DATE:	07/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:41 PM
MET WITH:	Andiana Serrano		TIME COMPLETED:	03:00 PM

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On July 26, 2023, Licensing Program Analyst (LPA) Stacey Williams met with Facility Representative, Andiana Serrano for the purpose of an unannounced required 1 year inspection. Program hours are Monday through Friday 6:30AM-6:30PM. Upon arrival there were (11) eleven children supervised by (3) three staff. Criminal record clearances have been verified.

LPA conducted a health and safety inspection for all areas accessible to children. Facility Representative stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. LPA observed a functional smoke/carbon monoxide detector and a fully charged 2A :10BC fire extinguisher. The floors appeared clean throughout the facility. Outdoor play area is free from dangerous conditions and playground equipment is securely anchored to the ground. There is sufficient resilient material underneath climbing structures. Shade is provided in the gazebo area of the yard.

Program provides breakfast, lunch, afternoon snack and super snack. Facility offers filtered drinking through a Brita and dispenses water from a pitcher where each child’s individual cup is filled. Lead Testing was discussed with the Program Lead. Program Lead stated the facility’s water outlets were tested for lead on July 1, 12023. Sign in/out sheet were reviewed and are conducted electronically.

Six child files were reviewed. Each file contained required licensing documents. Files for staff who were present at the facility were reviewed. Staff have a criminal record clearance, health screening report, immunization records, mandated reporter training, and documentation of their educational background, training, and/or experience. CPR certification was verified. Site Supervisor has a CPR expiration date 6/2025.

LPA reviewed the Department's inspection authority and discussed with staff any changes that may occur regarding Director/Site Supervisor or an employee acting in the director's absence must be reported to department within 10 working days.

Report continues on LIC 809-C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CATALYST KIDS - JACOBSON	FACILITY NUMBER: 393605862
	VISIT DATE: 07/26/2023

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Facility Representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Per Facility Representative there are children that require medication. Facility has an Incidental Medial Service Plan on file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

No Title 22 deficiencies were observed during today's inspection.

Exit interview conducted and report was reviewed with Facility Representative, Andiana Serrano. 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 Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC809 (FAS) - (06/04)

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