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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620608
Report Date: 06/15/2021
Date Signed: 06/15/2021 10:04:45 AM

Document Has Been Signed on 06/15/2021 10:04 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CATALYST KIDS - PARKER WHITNEYFACILITY NUMBER:
313620608
ADMINISTRATOR:LE, VANNAFACILITY TYPE:
840
ADDRESS:5145 TOPAZ AVETELEPHONE:
(916) 778-3092
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY: 50TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
06/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Lexi DonnellyTIME COMPLETED:
10:15 AM
NARRATIVE
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Licensing Program Analyst's (LPA's) Amanda Blesi arrived to the center at approximately 8:45am and was met by assistant director Lexi Donnelly for a required annual inspection. This facility is located on Parker Whitney Elementary School grounds in Portable 1, The facility operates Monday through Friday from 7:00 A.M. to 6:00PM.

LPA toured the facility including all activity/classroom areas, the isolation area, food service area, restrooms and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, furniture, equipment, drinking water and food service provisions. The facility uses the elementary school playground and the elementary school bathrooms.

LPA reviewed the children's Identification and Emergency Information. LPA reviewed personnel's education and immunization requirements utilizing KIT #2. All staff currently employed with the center have criminal record clearances and are associated to the Sunset Ranch site facility # 313620604 waiver on file. At least one staff member present today has current EMSA approved Pediatric/Child CPR and First Aid.

This facility provides Incidental Medical Services For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
To order forms please visit our website at www.ccld.ca.gov (report is continued on next page LIC 809-C)
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 - PARKER WHITNEY
FACILITY NUMBER: 313620608
VISIT DATE: 06/15/2021
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Mandated Reporter Training
LPA advised the Director on the new regulation AB 1207- California Child Care Worker: Mandated Reporter Training. All employees must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be could at: mandatedreporterca.com. LPA observed one staff missing the training.


Type B Title 22 deficiencies are cited on the subsequent pages of this report see LIC 809-D.

Licensing report was reviewed and discussed with director
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/15/2021 10:04 AM - It Cannot Be Edited


Created By: Amanda Blesi On 06/15/2021 at 09:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CATALYST KIDS - PARKER WHITNEY
FACILITY NUMBER: 313620608

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/29/2021
Section Cited
CCR
101217(a)(11)

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Personnel Records: The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information
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Director shall submit proof of correction to LPA by date indicated. 6/29/2021.
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A health screening as specified in Section 101216(g). This requirement was not met as evidenced by: staff Irena, and Liz were lacking a completed health screening in their employee file. This is a potential risk to children.
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Type B
06/29/2021
Section Cited
HSC1596.8662(b)(1)

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Personnel Records: On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Director shall submit proof of correction to LPA to this deficiency by date indicated. 6/29/2021.
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This requirement was not met as evidenced by: staff Liz employee file did not contain proof of completing mandated reporter 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.
SUPERVISOR'S NAME:Keven Peters
LICENSING EVALUATOR NAME:Amanda Blesi
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/15/2021 10:04 AM - It Cannot Be Edited


Created By: Amanda Blesi On 06/15/2021 at 09:50 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CATALYST KIDS - PARKER WHITNEY
FACILITY NUMBER: 313620608

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/29/2021
Section Cited
HSC
1596.7995(a)(1)

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Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year
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Director shall submit proof of correction to LPA by date indicated. 6/29/2021.
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This requirement was not met as evidenced by: employee Liz Zarate employee file did not contain proof of immunization for measles, pertussis or influenza.
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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.
SUPERVISOR'S NAME:Keven Peters
LICENSING EVALUATOR NAME:Amanda Blesi
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2021


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