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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820505
Report Date: 11/05/2024
Date Signed: 11/05/2024 01:49:12 PM

Document Has Been Signed on 11/05/2024 01:49 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CATALYST KIDS - SOUTHSHOREFACILITY NUMBER:
334820505
ADMINISTRATOR/
DIRECTOR:		MELISSA GOMEZFACILITY TYPE:
840
ADDRESS:30975 SOUTHSHORE DRIVETELEPHONE:
(951) 679-6401
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 4DATE:
11/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:America AngelesTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On Nvember 5, at 12:55 PM Licensing Program Analyst(LPA) Courtnee Peebles arrived at the facility to conduct a case management visit. LPA toured the facility inside and out and took a census. LPA arrived at the facility to deliver an amended 809D for complint #10-CC-20240830105946 delivered on 10/15/2024. LPA explained to the director the incorrect Title 22 regulation deficiency was utilized on the deficiency page 809D. A corrected form was given today.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Courtnee Peebles
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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