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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573604834
Report Date: 04/06/2022
Date Signed: 04/06/2022 10:10:20 AM


Document Has Been Signed on 04/06/2022 10:10 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 - TAFOYAFACILITY NUMBER:
573604834
ADMINISTRATOR:MIA JOHSNONFACILITY TYPE:
840
ADDRESS:720 HOMESTEADTELEPHONE:
(530) 666-9060
CITY:WOODLANDSTATE: CAZIP CODE:
95776
CAPACITY:70CENSUS: 0DATE:
04/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Site Supervisor, Andrea NolascoTIME COMPLETED:
10:20 AM
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Licensing Program Analysts (LPAs) Chayntel Hunter and Salene Mayberry met with Site Supervisor, Andrea Nolasco to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 03/31/2022. During today's visit the facility was toured. No school age children were present during the inspection.

LPAs interviewed the Site Supervisor and staff who were present during the incident. LPAs reviewed and discussed this report with the Site Supervisor.

The facility reported the UIR to Community Care Licensing within 24hrs. A written UIR was submitted within 7 days, describing the specifics of the incident.

Facility evaluation report was reviewed and discussed with Site Supervisor. 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: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
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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