304270758-6-8-2022-06-CC-PRIS-CF7NHP-20220608102903

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270758
Report Date: 06/08/2022
Date Signed: 06/08/2022 10:29:15 AM

Document Has Been Signed on 06/08/2022 10:29 AM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	CATALYST KIDS-TRIDENT		FACILITY NUMBER:	304270758
ADMINISTRATOR:	PHILLIPS, DEBBIE		FACILITY TYPE:	830
ADDRESS:	1800 WEST BALL ROAD		TELEPHONE:	(714) 999-5632
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	30	CENSUS: 5	DATE:	06/08/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Debbie Phillips		TIME COMPLETED:	10:45 AM

NARRATIVE

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Licensing Program Analysts Patricia Rivas and Patricia Duron conducted an unannounced Case Management visit. LPAs met with Director, Debbie Phillips to discuss the Lead Sampling Testing conducted on 06/8/22. Director was advised on 06/6/22 that the Lead Sample Report was to be posted. LPAs confirmed that Director had posted the Lead Sample Report.

Ms. Phillips was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA's toured rooms 23 and 24. Room 23 is currently not in use. LPAs observed 5 infants and 3 teachers in room 24. LPA's reviewed outlets G, H, I , J, K, L, M, all were made inaccessible via plastic bag wrapped around the drinking water outlets, and a sign "do not use".

Director stated the outlet with high levels of Lead are inoperable. They have made the drinking faucet/outlet that tested with high levels of Lead inoperable via plastic bag wrapped around the drinking faucet, tapped all around and a sign “do not use”, effective May 18, 2022. Facility is providing water bottles for drinking, portable sinks for hand washing, and using water from outlets that have passed lead test for cleaning.

LPAs were informed that all high lead levels outlets have been replaced effected June 4, 2022. They are currently doing the flushing for 3 weeks. Each day they are flushing four times a day.

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CATALYST KIDS-TRIDENT	FACILITY NUMBER: 304270758
	VISIT DATE: 06/08/2022

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Based on records reviewed and based on LPAs observations, director has had all outlets replaced. No citations issued.

Exit interview conducted and report was reviewed with the facility representative Debbie Phillips. 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

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

LIC809 (FAS) - (06/04)

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