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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619592
Report Date: 10/05/2022
Date Signed: 10/05/2022 03:13:07 PM

Document Has Been Signed on 10/05/2022 03:13 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CATALYST KIDS - CYRIL SPINELLIFACILITY NUMBER:
343619592
ADMINISTRATOR:BATEMAN-MCDOLE, JENNIFERFACILITY TYPE:
850
ADDRESS:3401 SCOTLAND DRIVETELEPHONE:
(916) 348-7415
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 24TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
10/05/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Jennifer Bateman-McDoleTIME COMPLETED:
03:20 PM
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On today's date Licensing Program Analyst (LPA) Fabiola Diaz arrived at the facility at around 2:35PM to follow-up on a Unusual Incident Report (UIR).

The UIR was regards to COVID-19. UIR was received via fax on 8/24/22. LPA spoke with Jennifer Batemann-McDole and completed the COVID-19 questionnaire during the visit.

No deficiencies were cited on today's date. A notice of site visit was provided and should remain posted for 30 days.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2022
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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