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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201349
Report Date: 04/08/2024
Date Signed: 04/08/2024 10:00:20 AM

Document Has Been Signed on 04/08/2024 10:00 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, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:CATALYST CARES ADULT DAY PROGRAMFACILITY NUMBER:
079201349
ADMINISTRATOR/
DIRECTOR:		FREEMAN, MAVISFACILITY TYPE:
775
ADDRESS:3905 SAN PABLO DAM ROADTELEPHONE:
(610) 390-5538
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY: 60CENSUS: 0DATE:
04/08/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Mavis Freemen, Administrator/ApplicantTIME VISIT/
INSPECTION COMPLETED:
09:55 AM
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Component II completion: Successful

Facility Type: Adult Day Program (ADP)
Application Type: Initial
Capacity: 60
Census (if any clients in care): none
COMP II Participants: Mavis Freemen, Administrator/Applicant
Interview Method: Telephone interview


On April 8, 2024 at 9:00 AM, Applicant/Administrator participated in COMP II. Identification of the Applicant/Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas:
1. Facility Operation: License type, client/resident populations, and program.
2. Admission Policies
3. Staffing Requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General Provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing Readiness

Exit interview conducted with Applicant/Administrator. Report sent via email and informed to return sign copy by end of business day today to CAB.
SUPERVISORS NAME: Darla Neeley
LICENSING EVALUATOR NAME: Celia Phomphachanh
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2024
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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