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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620609
Report Date: 09/26/2024
Date Signed: 09/26/2024 02:57:04 PM

Document Has Been Signed on 09/26/2024 02:57 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CATALYST KIDS - ANTELOPE CREEKFACILITY NUMBER:
313620609
ADMINISTRATOR/
DIRECTOR:
ALEXIS DONNOLLEYFACILITY TYPE:
840
ADDRESS:6185 SPRINGVIEW DRIVETELEPHONE:
(916) 778-3082
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: DATE:
09/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Alexis DonnolleyTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On Thursday, September 26, 2024, Licensing Program Analyst (LPA) Lea Habtom arrived to the Antelope Creek Elementary school campus and met with director, Alexis Donnolley for an unannounced required annual inspection. Upon arrival LPA observed 2 transitional kindergarten school age children being supervised by 1 staff and the director. The facility is located in the portable on the Antelope Creek Elementary school campus. Staff fingerprint clearances are associated to the Catalyst Kids Sunset Ranch #313620604. Facility hours of operation are Monday through Friday from 6:45am - 6:00pm.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA toured the classroom, restroom, and outdoor play area. One child requires medication. Medication was stored in a locked box inaccessible to children. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The facility uses the restrooms and play ground on school grounds. The floors appeared clean throughout the facility. All food was protected against contamination. Facility provides breakfast and pm snack. Drinking water was readily available to children both indoors and outdoors via labeled water bottles and water pitcher with disposable cups. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. Two staff and 4 children's records were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification. LPA reviewed the Department's inspection authority and discussed any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Report continued on 809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CATALYST KIDS - ANTELOPE CREEK
FACILITY NUMBER: 313620609
VISIT DATE: 09/26/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided an updated Plan of Operation that includes IMS must be submitted to the department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http?//www.ada.gov/childqanda.htm

Staff are encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers

There were no Title 22 Deficiencies cited during today's inspection.

Appeal Rights given. This report was reviewed with director Alexis Donnelly.



Exit interview conducted and report was reviewed with the facility representative, Alexis Donnolley. A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC809 (FAS) - (06/04)
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