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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393604766
Report Date: 04/15/2024
Date Signed: 04/15/2024 02:28:23 PM

Document Has Been Signed on 04/15/2024 02:28 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CATALYST KIDS - WANDA HIRSCHFACILITY NUMBER:
393604766
ADMINISTRATOR/
DIRECTOR:		RODRIGUEZ, MARIAFACILITY TYPE:
840
ADDRESS:1280 DOVE STREETTELEPHONE:
(209) 836-0977
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 22DATE:
04/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Maria RodriguezTIME VISIT/
INSPECTION COMPLETED:
02:55 PM
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On April 15, 2024, Licensing Program Analyst (LPA) Stacey Williams conducted a case management inspection and met with Site Supervisor, Maria Rodriguez. LPA toured the facility with facility staff. There were twenty two (22) students present during the inspection.

LPA conducted interviews with students regarding an incident report that was submitted to Community Care Licensing on March 22, 2024. LPA spoke to staff regarding updates concerning the incident.

Exit interview conducted and report was reviewed with the Site Supervisor, Maria Rodriguez. 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: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2024
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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