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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343600894
Report Date: 07/11/2023
Date Signed: 07/12/2023 08:47:15 AM

Document Has Been Signed on 07/12/2023 08:47 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CATALYST KIDS - FOULKS RANCHFACILITY NUMBER:
343600894
ADMINISTRATOR:GUZMAN, MARIAFACILITY TYPE:
840
ADDRESS:6211 LAGUNA PARK DRIVETELEPHONE:
(916) 684-0861
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 56TOTAL ENROLLED CHILDREN: 45CENSUS: 16DATE:
07/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Maria De GuzmanTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Corina Beckby met with Center Manager, Maria Guzman, to follow up on the Unusual Incident Report (UIR) submitted to Community Care Licensing on 7/3/23.

LPA toured the facility, observed the care and supervision of children, reviewed records and conducted interviews.

Facility evaluation report was reviewed and discussed with Center Manager, Maria Guzman. Exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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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