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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500716
Report Date: 03/03/2025
Date Signed: 03/03/2025 01:58:29 PM

Document Has Been Signed on 03/03/2025 01:58 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 - JOSEPH SIMSFACILITY NUMBER:
344500716
ADMINISTRATOR/
DIRECTOR:		SIMMONS, LEXIFACILITY TYPE:
850
ADDRESS:3033 BUCKMINSTER DRIVETELEPHONE:
(916) 691-6768
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 8DATE:
03/03/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Lexi SimmonsTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On 03/03/2025, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a case management inspection. LPA arrived at the center and was met by Director Lexi Simmons (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA conducted a tour of the facility and observed 8 preschool aged children being supervised by 2 staff members. LPA determined, through accessing Guardian, that 1 individual who was providing care and supervision to children, was not associated to the license. D1 emailed her support staff and had the individual associated while LPA was conducting the field visit. LPA cleared the citation and provided a letter to D1 as proof of clearance.
The lack of association posed an immediate risk to the health and safety of children in care. As a result, a Type-A deficiency was cited on a subsequent 809-D page and a Civil Penalty was assessed. D1 understands that all parents or authorized representatives of currently enrolled children must sign the LIC 9224 form and be available to the Department for review. D1 understands that parents or authorized representatives of children enrolling for up to one year must sign the LIC 9224 form and be available to the Department for review. D1 acknowledged that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809-D with Type A deficiencies for 30 days.
An exit interview was conducted, and the report was reviewed with Director Simmons. LPA provided Licensee Appeal Rights to D1. 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: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
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 03/03/2025 01:58 PM - It Cannot Be Edited


Created By: Katy Velazquez On 03/03/2025 at 01:41 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 - JOSEPH SIMS
FACILITY NUMBER: 344500716

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/04/2025
Section Cited
CCR
101216(i)(2)

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(i) Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall:...(2) Request a transfer of a criminal record clearance as specified in Section 101170(f)...
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Director Simmons contacted support staff to transfer the staff member to the license, under an umbrella waiver, that the facility has on file with the Department. LPA provided Director Simmons with a letter as proof that the citation had been cleared.
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This requirement was not met as evidenced by a staff member providing care and supervision to children on 03/03/2025,without being associated to the license. This 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.
SUPERVISOR'S NAME:Karyn Guerra
LICENSING EVALUATOR NAME:Katy Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2025


LIC809 (FAS) - (06/04)
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