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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500641
Report Date: 07/12/2022
Date Signed: 07/14/2022 11:21:51 AM

Document Has Been Signed on 07/14/2022 11:21 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-MIWOK VILLAGEFACILITY NUMBER:
344500641
ADMINISTRATOR:SHAYLA WILLIAMS BARNESFACILITY TYPE:
840
ADDRESS:10070 LOUSADA DRIVETELEPHONE:
(916) 686-6495
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 70TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/12/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cindy Sigala & Shayla Williams-BarnesTIME COMPLETED:
11:00 AM
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Application Specialist (AS) Alecia Sifuentes met with Center Managers, Cindy Sigala and Shayla Williams-Barnes for the purpose of an announced pre-licensing inspection. Licensee requests a school-age license to serve 70 school-age children from kindergarten and above. The facility is located at Miwok Village Elementary School. The program will operate Monday through Friday from 6:30 a.m. to 6:00 p.m. The fire clearance was granted and received on 6/30/2022. The facility will be providing afternoon snack during the school year and breakfast, lunch, and snacks during holidays and summer.

AS reviewed with Center Manager the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

INDOOR ACTIVITY SPACE:
There are two school-age classrooms located in rooms D04 and D05. AS observed a sufficient amount of equipment, tables and chairs. Medication and first aid kit will be stored in the cabinet. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Center Manager stated there are no poisons or firearms on the premises. AS observed a two sinks, one in each classroom. AS observed a functional carbon monoxide detector in the classroom. AS observed an electronic sign-in/sign-out system.

Licensee has requested a capacity of 70 school-age children. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, AS did not take measurements. The children will use the school’s restrooms, and a separate private restroom for the staff. Children who become ill during the day will be isolated in the teacher area and will use the staff restroom, if necessary.

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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-MIWOK VILLAGE
FACILITY NUMBER: 344500641
VISIT DATE: 07/12/2022
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OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a chain link fence that is at least four feet tall. AS observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by overhangs.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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

AS discussed the following: supervision; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Center Manager any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Center Manager was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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-MIWOK VILLAGE
FACILITY NUMBER: 344500641
VISIT DATE: 07/12/2022
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Exit interview conducted and report was reviewed with the Center Managers, Cindy Sigala and Shayla Williams-Barnes.

AS will issue a provisional license that will expire in 90 days on 10/10/2022. Once the provisional is issued, the following items are to be completed prior to expiration of the provisional license for final approval of license:

1. Final file review from Licensing Program Manager (LPM) Jeannie Smith.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022
LIC809 (FAS) - (06/04)
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