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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201349
Report Date: 04/23/2024
Date Signed: 04/23/2024 04:08:33 PM

Document Has Been Signed on 04/23/2024 04:08 PM - 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CATALYST CARES ADULT DAY PROGRAMFACILITY NUMBER:
079201349
ADMINISTRATOR/
DIRECTOR:		FREEMAN, MAVISFACILITY TYPE:
775
ADDRESS:3905 SAN PABLO DAM ROADTELEPHONE:
(510) 390-5538
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY: 60CENSUS: 0DATE:
04/23/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Mavis Freeman, CEO/Administrator TIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 04/23/24 around 2:00 PM. Lisha Holmes, Licensing Program Analyst (LPA) arrived announced to conduct a Component III for a pre-licensing inspection. LPA met with Mavis Freeman, Administrator (ADM) and explained the purpose of the visit. Currently, the facility does not have any clients.

LPA discussed the COVID-19 infection control, the importance of attending the informational calls, understanding the updated guidelines and printing the provider information notices (PINS) for clients, authorized representatives and staff so that the facility maintains awareness and updates for compliancy with the Title 22 regulations.

-Component III completed.

Exit interview conducted and a copy of this report provided to ADM.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
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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