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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393604765
Report Date: 12/17/2024
Date Signed: 12/17/2024 11:59:12 AM

Document Has Been Signed on 12/17/2024 11:59 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CATALYST KIDS - JACOBSONFACILITY NUMBER:
393604765
ADMINISTRATOR/
DIRECTOR:		SERRANO, ANDIANAFACILITY TYPE:
840
ADDRESS:1750 KAVANAGH STREETTELEPHONE:
(209) 832-8799
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 0DATE:
12/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:47 AM
MET WITH:Lee McCowanTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On December 17, 2024, Licensing Program Analyst (LPA), Stacey Williams conducted a case management inspection to the facility listed above. LPA met with Facility Representative, Lee McCowan. There were no children present.

LPA and Center Manager discussed an incident report that was submitted to Community Care Licensing on December 4, 2024. Interviews were conducted with staff regarding the incident.

Exit interview conducted and report was reviewed with Center Manager, Lee McCowan. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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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