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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
336300651
Report Date:
07/19/2023
Date Signed:
07/21/2023 10:08:54 AM
Document Has Been Signed on
07/21/2023 10:08 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 - MENIFEE
FACILITY NUMBER:
336300651
ADMINISTRATOR:
SMITH,RACHEL
FACILITY TYPE:
830
ADDRESS:
25625 BRIGGS RD.
TELEPHONE:
(951) 928-4000
CITY:
MENIFEE
STATE:
CA
ZIP CODE:
92596
CAPACITY:
36
TOTAL ENROLLED CHILDREN:
0
CENSUS:
DATE:
07/19/2023
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
01:15 PM
MET WITH:
TIME COMPLETED:
04:15 PM
NARRATIVE
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This report was generated under this facility in error.
SUPERVISORS NAME
:
Pauline Beschorner
LICENSING EVALUATOR NAME
:
Jessica M Rubio
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/19/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
3737 MAIN STREET, STE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
CATALYST KIDS - MENIFEE
FACILITY NUMBER:
336300651
VISIT DATE:
07/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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28
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32
This report was generated under this facility in error.
SUPERVISORS NAME
:
Pauline Beschorner
LICENSING EVALUATOR NAME
:
Jessica M Rubio
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/19/2023
LIC809
(FAS) - (06/04)
Page:
2
of
2