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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500641
Report Date: 06/07/2023
Date Signed: 06/07/2023 09:56:11 AM

Document Has Been Signed on 06/07/2023 09:56 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CATALYST KIDS - MIWOK VILLAGEFACILITY NUMBER:
344500641
ADMINISTRATOR:TRIGGS, MARIAFACILITY TYPE:
840
ADDRESS:10070 LOUSADA DRIVETELEPHONE:
(916) 686-6495
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 70TOTAL ENROLLED CHILDREN: 42CENSUS: 7DATE:
06/07/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Cindy SigalaTIME COMPLETED:
10:30 AM
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Application Specialist (AS) Alecia Sifuentes met with Center Manager, Cindy Sigala and Site Supervisor, Lisa McClelland for the purpose of a case management inspection. Licensee requests a room change to a new portable. Licensee is not making any changes to the capacity. The facility is located at Miwok Village Elementary School. The program operates Monday through Friday from 6:30 a.m. to 6:00 p.m.

A health and safety inspection was conducted in all areas accessible to children. Center Manager stated that the school-age program will now be occupying Portable 1 (room 1 & room 2). Center Manager stated that the elementary school’s annual fire inspection report does not include the new portable so AS has requested a Fire Safety Inspection (STD850). Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, AS did not take measurements. There are two toilets and three sinks. The children will also use the school’s restrooms, and there is a separate private restroom for staff.

Center Manager was reminded that all adults 18 and over, 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Center Manager, Cindy Sigala.

The following item is required before approval of the new portable:
1. Granted fire clearance (STD850)
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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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