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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573607080
Report Date: 06/18/2024
Date Signed: 06/18/2024 02:01:33 PM

Document Has Been Signed on 06/18/2024 02:01 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 - MONTGOMERYFACILITY NUMBER:
573607080
ADMINISTRATOR/
DIRECTOR:		ZAAHIDA KHANFACILITY TYPE:
840
ADDRESS:1441 DANBURY ST.TELEPHONE:
(530) 297-5014
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 22DATE:
06/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Director, Larry MurvineTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On June 18, 2024, Licensing Program Analyst (LPA) Lauren Scott met with Director, Larry Murvine to follow up on an Unusual Incident Report (UIR) that was reported to Community Care Licensing on 06/13/24.

LPA interviewed the Director who was present for the incident.

The facility reported the UIR to Community Care Licensing within 24 hours and were reminded to submit a written UIR was submitted within 7 days.

Facility evaluation report was reviewed and discussed with director. An exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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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