570313700-9-13-2021-53-CC-BENN-C6XM5M-20210917091830

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 570313700
Report Date: 09/13/2021
Date Signed: 09/13/2021 02:40:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2021 and conducted by Evaluator Chayntel Hunter

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20210902142733

FACILITY NAME:	CATALYST KIDS - BIRCH LANE		FACILITY NUMBER:	570313700
ADMINISTRATOR:	RUSSELL, RITA		FACILITY TYPE:	840
ADDRESS:	1700 BIRCH LANE		TELEPHONE:	(530) 758-7251
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY:	70	CENSUS: 9	DATE:	09/13/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Lily Smith, Interim Site Supervisor		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is operating out of ratio

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Chayntel Hunter and Christopher Jackson spoke with Interim Site Supervisor, Lily Smith to deliver the findings of the complaint investigation regarding the above allegation. During the course of the investigation, LPAs conducted interviews, and obtained information pertaining to allegation. It was alleged that the facility was operating out of ratio.

LPAs reviewed staff ratio counts which revealed that on Wednesday 8/25/21, the facility had a total of 34 children in attendence, with only two staff members. Facility stated that one staff member needed to leave and the facility was only out of ratio for about 45 minutes. Facility also stated that children were seperated in to smaller groups to maintain social distancing. Based on the interviews and review of records that revealed the facility was operating out of ratio, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Report continues on 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 5

Control Number 53-CC-20210902142733

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 - BIRCH LANE	FACILITY NUMBER: 570313700
	VISIT DATE: 09/13/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The following Title 22 Deficiency is being cited on the subsequent 9099-D pages. Upon receipt of Type A citations, licensee shall post and provide copies of the LIC 9099-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 LIC 9224, acknowledging receipt of LIC 9099-D in each child's file. Appeal Rights and Notice of Site Visit were provided.

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 53-CC-20210902142733

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 - BIRCH LANE	FACILITY NUMBER: 570313700
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/13/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/14/2021 Section Cited CCR 101516.5(b)	1 2 3 4 5 6 7	101516.5 Teacher-Child Ratio (b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Interim Site Supervisor stated that she has adjusted staff schedules to accomodate for ratios and is in the process of hiring additional staff to continue to meet ratio requirements. LPAs cleared defiency during visit.
	8 9 10 11 12 13 14	Based on interviews conducted and record reviews LPAs learned that on 8/25/21 there were two staff present with a total of 34 children. This is an immediate health and saferty risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 5