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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570313700
Report Date: 01/26/2023
Date Signed: 01/26/2023 04:26:58 PM

Document Has Been Signed on 01/26/2023 04:26 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CATALYST KIDS - BIRCH LANEFACILITY NUMBER:
570313700
ADMINISTRATOR:SMITH, LILYFACILITY TYPE:
840
ADDRESS:1700 BIRCH LANETELEPHONE:
(530) 758-7251
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 28DATE:
01/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Larry MurvineTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Salene Mayberry met with Site Supervisor Larry Murvine to follow up on the Unusual Incident Report submitted to Community Care Licensing on January 13, 2023. Twenty-eight school age children were present during the inspection.

During today's visit the facility was toured, and LPA interviewed a staff member who was present during the incident.

The facility evaluation report was reviewed with Site Supervisor. LPA provided Site Supervisor with a copy of the report. A Notice of Site Visit was posted, and Site Supervisor understands it must remain posted for 30 days, and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100.

No deficiencies were cited during this visit.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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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