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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570312613
Report Date: 12/28/2023
Date Signed: 12/28/2023 03:20:08 PM

Document Has Been Signed on 12/28/2023 03:20 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CATALYST KIDS - PIONEERFACILITY NUMBER:
570312613
ADMINISTRATOR:DIANNA ESPARZAFACILITY TYPE:
840
ADDRESS:5131 HAMEL STREETTELEPHONE:
(530) 758-0611
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 12DATE:
12/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:TIME COMPLETED:
03:35 PM
NARRATIVE
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On December 28, 2023, Licensing Program Analyst (LPA) Lauren Scott met with Site Supervisor, Cindy Flores, for the purpose of an unannounced Case Management inspection. LPA observed 12 children supervised by 3 staff.

On December 20, 2023, facility contacted CCLD regarding an Unusual Incident Report (UIR) that stated that one child walked out of the facility. Although a staff followed the child, the staff lost visual supervision for approximately two minutes within the elementary campus grounds.

Based on the interviews and information obtained, one Title 22 Deficiency has been issued on the attached LIC 809-D. The facility was informed that this report dated 12/28/2023 documents one Type A citation which shall be posted for 30 consecutive days. The facility shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. Because the citation involved an absence of supervision, an immediate civil penalty of $500 has been issued. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Facility has been provided with appeal rights.

Exit interview conducted and report was reviewed with Site Supervisor, Cindy Flores. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2023
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 12/28/2023 03:20 PM - It Cannot Be Edited


Created By: Lauren Scott On 12/28/2023 at 02:04 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 - PIONEER
FACILITY NUMBER: 570312613

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/29/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision... (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by:
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Facility will conduct a staff meeting discussing proper supervision of children within the facility. Facility will create a plan regarding how to prevent and handle elopements of children. Facility will submit meeting notes to LPA with staff signatures of attendance and acknowledgement
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Based on the information obtained from the UIR and interviews conducted, it was revealed visual of one child was lost for approximately 2 minutes. The facility did not comply with the section cited above which poses 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:Chayntel Hunter
LICENSING EVALUATOR NAME:Lauren Scott
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2023


LIC809 (FAS) - (06/04)
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