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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570310386
Report Date: 12/15/2023
Date Signed: 12/15/2023 02:15:44 PM

Document Has Been Signed on 12/15/2023 02:15 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 - CESAR CHAVEZFACILITY NUMBER:
570310386
ADMINISTRATOR:NOLASCO, ANDREAFACILITY TYPE:
840
ADDRESS:1221 ANDERSON ROADTELEPHONE:
(530) 753-3808
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY: 124TOTAL ENROLLED CHILDREN: 124CENSUS: DATE:
12/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Itzel RamirezTIME COMPLETED:
02:15 PM
NARRATIVE
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On December 14, 2023 Licensing Program Analysts (LPA) Jennie Tedlos met with Program Lead, Itzel Ramirez (PL) to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on December 5, 2023. LPA started the visit on December 14th, and continued the case management inspection the following day on December 15th. During today's visit, December 15th, present were 3 children in care and 3 staff.

On November 28, 2023 an incident occurred, where PL received an email by concerned parents of a child (C1) regarding C1 and another student (C2). The parents stated that C1 and C2 were told by a teacher (T1) that they could be Student of the Week for a second time if they give T1 arm massages. LPA conducted interviews that support the reported incident. Per the Program Lead, immediately following the incident, corrective actions had taken place by the facility and staff trainings have been scheduled.

A deficiency is being cited based on LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A Type A violation regarding Personal Rights is hereby assessed.

Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files.


An exit interview was conducted and Plans of Correction were reviewed and developed with the Program Lead. A copy of this report and appeal rights were discussed and left with Program Lead. A notice of site visit was provided and posted by LPA and must remain posted for 30 days.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2023
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 12/15/2023 02:15 PM - It Cannot Be Edited


Created By: Jennie Tedlos On 12/14/2023 at 02:53 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 - CESAR CHAVEZ
FACILITY NUMBER: 570310386

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/26/2023
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights: (a)...licensee shall ensure that each child is accorded...personal rights...(3)... free from corporal or unusual punishment...humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature... This requirement was not met as evidenced by:
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Program Lead took administrative action immediately following the incident. Staff meetings were conducted regarding staff scheduling, children's personal rights, and "if you see something, say something" to administration. Another staff meeting will be conducted on 12/18/23. PL will
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T1 received an arm massage from C1 and C2 during class. T1 told C1 and C2 that bonus points towards the Student of the Week program would be given either before or after the massage was given. This poses an immediate risk to the health and safety of children in care.
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schedule a training with DSS about Children's Personal Rights by emailing LPA. Facility will email LPA with meeting minutes and staff signatures by the POC due date.

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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:Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2023


LIC809 (FAS) - (06/04)
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