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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 570312670
Report Date: 08/29/2024
Date Signed: 09/04/2024 10:23:21 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2024 and conducted by Evaluator Jennie Tedlos
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240610114852
FACILITY NAME:CATALYST KIDS - ROBERT E. WILLETTFACILITY NUMBER:
570312670
ADMINISTRATOR:SAVANAH COVARRUBIASFACILITY TYPE:
840
ADDRESS:1207 SYCAMORE LANETELEPHONE:
(530) 758-8342
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:70CENSUS: 4DATE:
08/29/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Alex LuTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Facility is not providing a safe enviornment

***This report is amended from an original report dated 8/29/24.***
****Teacher, Zoe Smith, signed today's amended report on 9/4/24.*****
INVESTIGATION FINDINGS:
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On August 28, 2024, Licensing Program Analyst (LPA) Jennie Tedlos met with Lead Teacher, Alex Lu to deliver the findings of the complaint investigation regarding the above allegation. LPA observed45 children supervised by 5 staff.

LPA Tedlos conducted an investigation regarding the complaint allegations listed above. LPA toured the facility, conducted interviews with the Reporting Party (RP), Staff Members, Children enrolled at the facility and parents of children that attend or who have attended the facility. LPA also obtained pertinent information to assist with the investigation.

It was alleged that the facility is not providing a safe environment. It was revealed through interviews that a child (Child 1) has been causing injury to other children in care. The facility has reached out to Catalyst Kids Administration for guidance on improving Child 1’s behaviors. The staff has attempted to implement...
Report continues onto 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 53-CC-20240610114852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CATALYST KIDS - ROBERT E. WILLETT
FACILITY NUMBER: 570312670
VISIT DATE: 08/29/2024
NARRATIVE
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...positive reinforcement, redirection, bonding activities, increased supervision or shadowing, and discussions with Child 1 about emotions. However, according to staff, parent, and children’s interviews, Child 1’s behaviors have continued, resulting in an unsafe environment to other children in care.

Based on interviews, file review, and observations conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A Type-B Deficiency is cited on a subsequent 9099-D page. An exit interview was conducted, and the report was reviewed with the Lead Teacher, Alex Lu.

LPA provided Lead Teacher Alex Lu with Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20240610114852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CATALYST KIDS - ROBERT E. WILLETT
FACILITY NUMBER: 570312670
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
08/30/2024
Section Cited
CCR
101223(a)(3)
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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights:...(2) To be accorded safe, healthful and comfortable accommodations... to meet his/her needs.

This regulation was not met as evidenced by:
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The facility has reached out to Catalyst Kdis Administration for support. Facility staff has attempted positive reinforcement, redirection, and activities to help with Child 1's behaviors.The facility staff will watch CCLD training video on Children's Personal Rights...
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LPA learned that Child 1 has been causing injury to other children in care. This poses a potential health & safety and personal rights risk to children in care.
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...and send staff signatures to LPA stating that staff has completed the training.
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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.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC9099 (FAS) - (06/04)
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