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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343600618
Report Date: 09/27/2024
Date Signed: 09/27/2024 04:09:31 PM

Document Has Been Signed on 09/27/2024 04:09 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: 5DATE:
09/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Krystle MitchellTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
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On 09/27/2024 Licensing Program Analyst (LPA) Loraine Perez and Licensing Program Manager (LPM) Amanda Blesi met with Facility Representative Krystal Mitchell for the purpose of an unannounced case management inspection. LPAs were at the facility to conduct an annual inspection for the preschool license when it was observed school age program occupied classroom 3 which is designated for preschool use only.

A deficiency is being cited on the following page LIC809D.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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
Document Has Been Signed on 09/27/2024 04:09 PM - It Cannot Be Edited


Created By: Loraine Perez On 09/27/2024 at 03:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CATALYST KIDS - NORTH COUNTRY
FACILITY NUMBER: 343600618

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2024
Section Cited
CCR
101538..3(b)

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In combination programs, indoor activity space provided for school-age child care center children shall be physically separated from space provided for infant care and child care center children.
This requirement is not met as evidenced by:
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Facility Representative stated she will apply to update the license associated with room 3 from preschool use to school age.
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Based on observation school age children were present in the preschool classroom 3. No preschool children were present in the classroom.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Amanda Blesi
LICENSING EVALUATOR NAME:Loraine Perez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2024


LIC809 (FAS) - (06/04)
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