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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393605862
Report Date: 11/29/2023
Date Signed: 11/29/2023 02:32:38 PM


Document Has Been Signed on 11/29/2023 02:32 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:
393605862
ADMINISTRATOR:MALISSA MASTROPIERROFACILITY TYPE:
850
ADDRESS:1750 KAVANAGH STREETTELEPHONE:
(209) 832-8799
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:48CENSUS: 12DATE:
11/29/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Janet ShafferTIME COMPLETED:
02:45 PM
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On November 29, 2023 Licensing Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose conducting a plan of correction inspection. LPA met with Facility Representative, Janet Shaffer. LPA observed twelve children supervised by three staff.

The facility was inspected on November 3, 2023 at which time deficiencies were cited related regarding supervision. A plan of correction was developed during the inspection. LPA reviewed training material and roster during today's inspection.

Exit interview conducted and report was reviewed with Facility Representative, Janet Shaffer. 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: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
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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