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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 10:21:21 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
08/29/2024 and conducted by Evaluator Jennie Tedlos
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240829095857
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 operating out of ratio.

***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 to initiate the complaint investigation regarding the above allegation. LPA's observed 4 children supervised by 5 staff.

While initiating the complaint, LPA Tedlos conducted toured the facility, conducted interviews with the Staff Members of the facility and record review. LPA obtained pertinent information to assist with the investigation. Review of staff schedule's and review of the facility's "Face to Name Master List and Teacher to Child Ratio", LPA Tedlos was able to determine the facility has operated over ratio on more than one occasion.

Based on the interviews and review of records, it was revealed facility did not fully adhere to proper ratios, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22 regulations are being cited on the attached 9099-D page.
Report continues on 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-20240829095857
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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Based on interviews and file reviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A Type-A Deficiency is cited on a subsequent 9099-D page.

Upon receipt of Type A citations, the facility shall post and provide copies of the LIC 9099D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 9099D in each child's files.

An exit interview was conducted, and the report was reviewed with the Lead Teacher, Alex Lu.

***This report is amended from an original report dated 8/29/24.***


****Teacher, Zoe Smith, signed today's amended report on 9/4/24.*****
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
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:
FACILITY NUMBER:
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2024
Section Cited
CCR
101516.5(b)(1)
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101516 Teacher-Child Ratio...(b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance.(1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children.
This regulation was not met as evidenced by:
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The facility will not go over ratio and maintain a teacher-child ratio of 1:14 at all times. The facility will send LPA an updated teacher's schedule to reflect the appropriate Teacher ratios with Children in care by the POC due date.
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LPA learned through interview and record review that the facility has been out of ratio on multiple occasions. This poses an immediate health, safety, and personal rights risk to children in care.
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***This report is amended from an original report dated 8/29/24.***
****Teacher, Zoe Smith, signed today's amended report on 9/4/24.*****
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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)
Page: 3 of 3