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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570319082
Report Date: 04/14/2022
Date Signed: 04/14/2022 10:28:59 AM


Document Has Been Signed on 04/14/2022 10:28 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 - PATWINFACILITY NUMBER:
570319082
ADMINISTRATOR:BAYER, MAGDALENFACILITY TYPE:
840
ADDRESS:2222 SHASTA DRIVETELEPHONE:
(530) 756-1369
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:53CENSUS: 4DATE:
04/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Savannah Rodriguez, Site SupervisorTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Salene Mayberry and Licensing Program Manager (LPM) Bettina Engelman met with Site Supervisor, Savannah Rodriguez to follow up on three Unusual Incident Reports (UIRs) submitted to Community Care Licensing on 03/24/2022, 03/31/2022 and 04/07/2022. During today's visit the facility was toured. Four school age children were present during the inspection.

Licensing staff interviewed the Site Supervisor and reviewed records.

The facility evaluation report was reviewed and discussed with Site Supervisor. An Exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with the 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: Salene MayberryTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022
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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