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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343600618
Report Date: 11/08/2024
Date Signed: 11/08/2024 03:51:04 PM

Document Has Been Signed on 11/08/2024 03:51 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 - NORTH COUNTRYFACILITY NUMBER:
343600618
ADMINISTRATOR/
DIRECTOR:		MITCHELL, KRYSTLEFACILITY TYPE:
840
ADDRESS:3901 LITTLE ROCK DRIVETELEPHONE:
(916) 332-5185
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 99TOTAL ENROLLED CHILDREN: 99CENSUS: 39DATE:
11/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Krystle MitchellTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Loraine Perez met with Director Krystle Mitchell, Staff (S1) Pearl H, regarding an Unusual Incident that took place October 28th, 2024. There is a census of 39 school age children. LPA made observations, interviewed staff and children regarding the incident.

On 10/28/2024 at approximately 2:00 PM C1 was walking fast and tripped, causing her to fall. She used her right arm to break her fall. Staff members informed Director about the incident, and Director self reported the incident to the department, investigated, interviewed staff and witnesses, informed parent/guardian of child and took necessary steps/actions needed for Catalyst Kids.

No Title 22 Deficiencies observed in the areas that were evaluated. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Krystle Mitchell.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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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