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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393610025
Report Date: 05/30/2023
Date Signed: 05/30/2023 10:43:19 AM


Document Has Been Signed on 05/30/2023 10:43 AM - 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 - WICKLUNDFACILITY NUMBER:
393610025
ADMINISTRATOR:TREJO, STEPHANIEFACILITY TYPE:
840
ADDRESS:300 EAST LEGACYTELEPHONE:
(209) 832-5834
CITY:MOUNTAIN HOUSESTATE: CAZIP CODE:
95391
CAPACITY:70CENSUS: 6DATE:
05/30/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Marti Rhoades TIME COMPLETED:
10:48 AM
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On May 30, 2023, Licensing Program Analyst (LPA) Stacey Williams met with Site Supervisor, Marti Rhoades to follow up on the Unusual Incident Report (UIR) submitted to Community Care Licensing on May 15, 2023.

LPA toured the facility, observed the care and supervision of children, reviewed records and conducted interviews.

Facility evaluation report was reviewed and discussed with Site Supervisor, Marti Rhoades. 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.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2023
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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