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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570312615
Report Date: 09/01/2022
Date Signed: 09/01/2022 12:13:08 PM


Document Has Been Signed on 09/01/2022 12:13 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:CATALYST KIDS - NORTH DAVISFACILITY NUMBER:
570312615
ADMINISTRATOR:ROWE, NICOLEFACILITY TYPE:
840
ADDRESS:607 EAST 14TH STREETTELEPHONE:
(530) 756-4350
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:112CENSUS: 9DATE:
09/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Evila FloresTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Salene Mayberry met with Center Manager Evila Flores to follow up on a Unusual Incident Report submitted to Community Care Licensing on August 26, 2022. During today's visit, LPA toured the facility, conducted interviews and obtained information pertinent to the incident.

The center self-reported that on 8/18/22, during the morning transition outside, Child 1 (C1) left the group, remaining in the bathroom. Teacher 1 (T1) and Teacher 2 (T2) took the children in Classroom 2 outside. T1 told Center Manager they scanned the room before leaving and saw the bathroom door open with the lights off, and that they believed C1 was hiding behind the bathroom door. Approximately eight minutes later a separate staff member was inside prepping lunch when they saw C1 walk out of the bathroom. This staff member immediately walkied all the teachers who were outside and requested a count. It was determined that T1 and T2 were unaware of C1 being left behind.

A Type A deficiency was cited on the subsequent page of this report (LIC809-D). Upon receipt of Type A citations, Licensee shall post and provide copies of the LIC809-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed "Acknowledgment of Receipt of Licensing Reports" (LIC9224) of the LIC809-D in each child's file.

An Exit interview was conducted where the facility evaluation report and appeal rights were reviewed and provided to Center Manager. LPA posted the Notice of Site Visit. Center Manager acknowledges that it must remain posted for 30 days, and that a 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: Salene MayberryTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
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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Document Has Been Signed on 09/01/2022 12:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833


FACILITY NAME: CATALYST KIDS - NORTH DAVIS
FACILITY NUMBER: 570312615

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/01/2022
Section Cited

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Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without supervision. . .Supervision shall include visual observation. This requirement was not met as evidenced by the following:
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Center staff self-reported to Licensing that on August 18, 2022, a lack of supervision lead to a child being left unattended in the classroom. This poses and immediate risk to the health and safety of children in care.
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acknowledgment was provided to Licensing.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene MayberryTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
LIC809 (FAS) - (06/04)
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