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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617318
Report Date: 09/06/2023
Date Signed: 09/06/2023 01:02:33 PM

Document Has Been Signed on 09/06/2023 01:02 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 - ELLIOTT RANCHFACILITY NUMBER:
343617318
ADMINISTRATOR:SHAYLA WILLIAMS-BARNESFACILITY TYPE:
850
ADDRESS:10000 EAST TARON DRTELEPHONE:
(916) 714-2313
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 24TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
09/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Nancy TorresTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Corina Beckby met with Center Manager, Nancy Torres to follow up on the Unusual Incident Report (UIR) called into Community Care Licensing on August 31, 2023.

The center self reported on 8/30/23, that a student kicked a teacher in the leg. In response, the teacher grabbed the students leg and raised her other hand at the child, but did not make contact. LPA toured the facility, observed the care and supervision of 8 children by 1 Teacher and 2 Assistants, reviewed records, reviewed roster, and conducted interviews.

A Type B deficiency was cited on the subsequent page (809-D) of this report.

Facility evaluation report was reviewed and discussed with licensee. 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.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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Document Has Been Signed on 09/06/2023 01:02 PM - It Cannot Be Edited


Created By: Corina Beckby On 09/06/2023 at 11:53 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CATALYST KIDS - ELLIOTT RANCH
FACILITY NUMBER: 343617318

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
CCR
101223(a)(3)

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Personal RIghts 101223(e)(3) The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation...coercion, threat, mental abuse or other actions...
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Teacher was placed on Paid Administrative Leave on 9/1/23 until furhter notice. The teacher resigned and placed her 2 weeks notice on 9/1/23. Program Quality Manager will visit the center and talk about different strategies in the classroom to address childrens difficult behavior.
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This requirement was not met as evidenced by: a teacher grabbed the leg of a child and raised her other hand and moved her hand in a forward motion as to hit him, but she stopped herself before making contact.
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Teachers will watch Positive Behavior Support videos on Paycom & attend Program Quality calls. Behavior Observation Reports are being recorded to help assess triggers in the classroom. Center Manager will discuss appropriate discipline policy with staff and send mtg notes with staff signatures.

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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:Bettina Engelman
LICENSING EVALUATOR NAME:Corina Beckby
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023


LIC809 (FAS) - (06/04)
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