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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008822
Report Date: 04/17/2024
Date Signed: 04/17/2024 03:25:19 PM

Document Has Been Signed on 04/17/2024 03:25 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:CATALYST KIDS - ANDERSONFACILITY NUMBER:
483008822
ADMINISTRATOR/
DIRECTOR:		JOHNSON, MIAFACILITY TYPE:
850
ADDRESS:415 EAST C STREETTELEPHONE:
(408) 556-7300
CITY:DIXONSTATE: CAZIP CODE:
95620
CAPACITY: 60TOTAL ENROLLED CHILDREN: 19CENSUS: 13DATE:
04/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Mia JohnsonTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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An unannounced case management inspection was conducted today at 1:25pm by Licensing Program Analyst (LPA), Laura Chavez met with Center Manager Mia Johnson in response to an incident that was self-reported on 3/14/2024 to Community Care Licensing Division. The written report was received by the Department on 3/20/2024. The reporting requirements of the Department were met.

It was reported that on 3/13/2024 at approximately 11:30 am, Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3) transitioned 18 children from the outdoor play area to inside the classroom. Children and staff entered the classroom leaving Child #1 (C1) outside alone in the outdoor play area without S1, S2 and S3's knowledge.

CM reported that on 3/13/2024 at approximately 11:30am during the transition from the outdoor play area to inside the classroom, S1, S2, and S3 left C1 alone in the outdoor play area. CM stated she heard the door going into Classroom #1 closing leaving her to believe that S1, S2, and S3 did not realize C1 had been left alone in the outdoor play area. CM said she and Program Leader (PL) who were meeting in her office located in Classroom #2 observed from the office window that C1 had been left outside alone in the outdoor play area. CM said PL immediately went outside to get C1 while she continuously kept her eyes on C1 through the office window. CM stated that C1 was left outside for less than one minute. C1's parents were immediately notified of the incident.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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 04/17/2024 03:25 PM - It Cannot Be Edited


Created By: Laura Chavez On 04/17/2024 at 02:08 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: CATALYST KIDS - ANDERSON
FACILITY NUMBER: 483008822

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time. Supervision shall include visual observation.
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Center Manager agrees to provide a written statement on how visual supervision will be maintained at all times. All staff shall be provided training on maintaining supervision at all times.
The plan of correction shall include a sign-in sheet of all staff provided the training.
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This requirement is not met as evidenced by: Based on the information provided and staff interviews it was determined that a child was left alone in the outdoor play area without the staff's knowledge which posed a potential health, safety or personal rights risk to children in care.
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The plan of correction shall be submitted to CCLD on or before 5/17/2024.

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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:Megan Aviles
LICENSING EVALUATOR NAME:Laura Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CATALYST KIDS - ANDERSON
FACILITY NUMBER: 483008822
VISIT DATE: 04/17/2024
NARRATIVE
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S3 and PL were interviewed on 4/17/2024 stated that S1, S2, and S3 left C1 alone in the outdoor play area without their knowledge. PL stated that she and CM were in a meeting when they observed C1 alone in the outdoor play area through the office window. PL said she immediately went outside to get the child from the outdoor play area. S3 and PL corroborated that C1 was left alone in the outdoor play area no more than 30 seconds to one minute.

Based on the information provided and staff interviews it is determined that a lack of supervision did occur after C1 was left alone in the outdoor play area without the knowledge of S1, S2 and S3. The following deficiency is being cited on the LIC809-D - 101229(a)(1): Responsibility for Providing Care and Supervision.

An exit interview was conducted, and the report was reviewed with Center Manager Mia Johnson. Appeal Rights were provided. 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.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC809 (FAS) - (06/04)
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