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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343603167
Report Date: 02/06/2025
Date Signed: 02/06/2025 03:49:23 PM

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
01/21/2025 and conducted by Evaluator Katy Velazquez
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20250121013840
FACILITY NAME:CATALYST KIDS - ELITHA DONNERFACILITY NUMBER:
343603167
ADMINISTRATOR:WILSON, IRENEFACILITY TYPE:
840
ADDRESS:9461 SOARING OAKS DRIVETELEPHONE:
(916) 683-5526
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:98CENSUS: 3DATE:
02/06/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kimberly RammTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff left a daycare child unsupervised while in care.
Staff did not properly report an incident involving a daycare child.
INVESTIGATION FINDINGS:
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On 02/06/2025, Licensing Program Analyst Katy Velazquez (LPA) conducted an unannounced complaint investigation to deliver the findings for the above allegations. LPA met with acting Site Supervisor Kimberly Ramm (S1). Throughout the course of the investigation, LPA conducted physical plant inspections, on-site observations, interviews, reviewed and collected documentation. It was alleged that staff members, S2 and S3, left a daycare child (C1) unsupervised while in care and did not report an incident involving a daycare child.
Interviews and documentation reveal that on 01/15/2025, a child was left alone in the bathroom for an undetermined amount of time when S3 took the children outside to the playground without conducting a face-to-name check. It was revealed that staff and managment were made aware of the incident; however, the parent(s) of the child nor the Department were notified of this unusual incident.

CONTINUED ON LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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 4
Control Number 53-CC-20250121013840
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 - ELITHA DONNER
FACILITY NUMBER: 343603167
VISIT DATE: 02/06/2025
NARRATIVE
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Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. A Type-B and a Type-A deficiency were cited on a subsequent 9099-D page(s).
S1 acknowledges, that FOR TYPE A DEFICIENCIES ONLY, upon receipt, licensee shall post LIC 9099-D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee.
An exit interview was conducted, and the report was reviewed with Site Supervisor Ramm. LPA provided Licensee Appeal Rights to S1. 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: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 53-CC-20250121013840
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 - ELITHA DONNER
FACILITY NUMBER: 343603167
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/07/2025
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision...
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time,...
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Staff members of this facilty will recieve training in supervision. The training will include CDSS videos "Teacher-to-child Ratios in Child Care Centers" and "Supervising Chidlren in Child Care Centers." A signed attendance log will be emailed to LPA by 5:00 PM on 02/07/2025.
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This requirement was not met as evidenced by a child being left alone in the bathroom on 01/15/2025, when the staff exited the building. This absence of supervision poses/posed an immediate health, safety or personal rights risk to persons 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.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 53-CC-20250121013840
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 - ELITHA DONNER
FACILITY NUMBER: 343603167
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2025
Section Cited
CCR
101212(d)
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Reporting Requirements...(d)...a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven
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The Director and Site Supervisor/Program Lead of this facility will watch CDSS video "Child Care Reporting Requirements." The Director and Site Supervisor/Program Lead will sign a statement confirming that they watched thie video in entirety. The signed statement will be emailed to LPA
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 days following the occurrence of such event.
This requirement was not met as evidenced by an unusual incident on 01/15/2025 not being reported to the Department. 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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by 5:00 PM on 02/28/2025.
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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: Katy Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4