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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603167
Report Date: 01/23/2025
Date Signed: 01/23/2025 03:16:30 PM

Document Has Been Signed on 01/23/2025 03:16 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CATALYST KIDS - ELITHA DONNERFACILITY NUMBER:
343603167
ADMINISTRATOR/
DIRECTOR:		WILSON, IRENEFACILITY TYPE:
840
ADDRESS:9461 SOARING OAKS DRIVETELEPHONE:
(916) 683-5526
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 98TOTAL ENROLLED CHILDREN: 98CENSUS: 5DATE:
01/23/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Mia JohnsonTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 01/23/2025, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility. LPA arrived at the facility and disclosed the purpose of the inspection, and LPA was granted entrance. LPA met with Center Manager Mia Johnson (D2). LPA toured the facility and observed 5 school aged children being supervised by 2 staff members. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.

When LPA arrived at the facility, there was not a Director nor Cite Supervisor present. LPA was able to determine that the Director of Record (DOR), Irene Wilson, was no longer an employee of Catalyst Kids. Employees stated that Center Manager Mia Johnson was the DOR; however, the LIC 500 documents Diana Esparza as the DOR. The facility did not report the change of Directorship to the Department. The lack of reporting poses/posed a potential risk to the health, safety, and personal rights of person(s) in care. As a result, a Type-B deficiency was cited on a subsequent 809-D page.

While on site, LPA observed an adult staff member use the restroom that is allocated to children; this poses/posed a potential risk to the health, safety, and personal rights of person(s) in care. As a result, a Type-B deficiency was cited on a subsequent 809-D page.

An exit interview was conducted, and the report was reviewed with Center Manager Mia Johnson. LPA provided D2 with Licensee 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: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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Document Has Been Signed on 01/23/2025 03:16 PM - It Cannot Be Edited


Created By: Katy Velazquez On 01/23/2025 at 02:40 PM
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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CATALYST KIDS - ELITHA DONNER
FACILITY NUMBER: 343603167

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/30/2025
Section Cited
CCR
101212(b)

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Reporting Requirements (b) The name of the child care center director,...,shall be reported to the Department within 10 days of a change of child care center director or designee(s).
Thie requirement was not met as evidenced by the DOR Irene Wilson
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Center Manager Mia Johnson will email LPA a Director's packet for a qualifid individual by 5:00 PM on 01/30/2025.
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was reported to the Department in May 2024 and is no longer an employee at the facilty. No Director was reported since May 2024. The lack of reporting poses or posed a potential risk to the health, safety, and personal rights of person(s) in care.
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Type B
01/30/2025
Section Cited
CCR101239(i)

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Fixtures, Furniture, Equipment and Supplies (i)There shall be one toilet and one handwashing fixture, separate from and in addition to the number of toilets and handwashing fixtures required in (h) above, designated for use by children...
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Center Manager Mia Johnson will create a bathroom policy for staff members that includes instructions for using the adult bathroom on the Elementary campus. Staff will sign the policy. The signed policy will be emailed to LPA by 5:00 PM on 01/30/2025.
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This requirement was not met as evidenced by LPA observing an adult staff member using the bathroom designated for children and bathroom used in the capacity of children. This poses or posed a potential risk to the health, safety, and personal rights of person(s) in care.
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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:Karyn Guerra
LICENSING EVALUATOR NAME:Katy Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2025


LIC809 (FAS) - (06/04)
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