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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841029
Report Date: 07/22/2021
Date Signed: 07/22/2021 11:17:41 AM

Document Has Been Signed on 07/22/2021 11:17 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CATALYST KIDS - MENIFEEFACILITY NUMBER:
334841029
ADMINISTRATOR:RACHEL M SMITHFACILITY TYPE:
850
ADDRESS:25625 BRIGGS ROADTELEPHONE:
(951) 928-4000
CITY:MENIFEESTATE: CAZIP CODE:
92585
CAPACITY: 144TOTAL ENROLLED CHILDREN: 0CENSUS: 68DATE:
07/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH: Center Manager- RachelTIME COMPLETED:
11:26 AM
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 Licensing Program Analyst (LPA) Otsanya Cameron arrived at the facility for the purpose of obtaining signatures for a previous report. LPA toured the facility and confirmed a census of 68.

Due to FAS consistency check, LPA was not able to obtain all signatures and leave copies of the reports dated 7/21/21. SIgnatures were obtained on today's visit.

A notice of site visit along with copies of all reports were provided.
SUPERVISORS NAME: Dawn Parker
LICENSING EVALUATOR NAME: Otsanya Cameron
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2021
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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