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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570312670
Report Date: 03/17/2022
Date Signed: 03/18/2022 07:53:12 AM


Document Has Been Signed on 03/18/2022 07:53 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:CATALYST KIDS - ROBERT E. WILLETTFACILITY NUMBER:
570312670
ADMINISTRATOR:ANGELO, MARISSAFACILITY TYPE:
840
ADDRESS:1207 SYCAMORE LANETELEPHONE:
(530) 758-8342
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:70CENSUS: 0DATE:
03/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Shannon Kumar, Interim Assistant Site SupervisorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst Salene Mayberry and Licensing Program Manager Bettina Engelman met with Interim Assistant Site Supervisor Shannon Kumar for the purpose of a case management visit regarding an unusual incident reported on February 28, 2022. Licensing staff toured the facility, reviewed records and conducted interviews. No children were present at the time of the inspection.

No deficiencies were cited during this visit.

An exit interview conducted. A notice of site visit and appeal rights were provided.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene MayberryTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
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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