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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270761
Report Date: 04/21/2022
Date Signed: 04/21/2022 12:59:33 PM


Document Has Been Signed on 04/21/2022 12:59 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:CATALYST KIDS-LINDBERGHFACILITY NUMBER:
304270761
ADMINISTRATOR:SOTO, GERARDOFACILITY TYPE:
850
ADDRESS:220 23RD STREETTELEPHONE:
(949) 650-2506
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY:256CENSUS: 108DATE:
04/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Gerardo Soto, DirectorTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analysts Patricia Rivas and Patricia Duron conducted an unannounced Case Mangement visit . LPAS met with Director, Gerardo Soto to discuss the Lead Sampling Testing conducted on 03/26/22. Director was advised on 04/20/22 that the Lead Sample Report was to be posted. LPAs confirmed the Director had posted the Lead Sample Report.
Mr. Soto stated the outlets with high lead levels are inoperable. They have made faucets/outlets that tested with high lead levels inoperable via caution tape; signs, covering. One outlet is in a room#14 that has been permanently closed, used for storage. Room#14 is locked, inaccessible to staff and children; the only key available is held by Director, Soto. The second outlet is in the kitchen prep area only accessible by staff. LPAs viewed posted signs, taped. outlet. Third outlet is in room#19 it has been taped off and closed. Source of drinking water is from water bottles brought by children and refilled by staff using the water faucet outside of room #19. LPA was advised that they have put in a ticket with the Newport Mesa School District to replace outlets . Newport Mesa School District personnel will advise them of when will be done.

Based on LPAs record reviews the following violation was observed and is being cited in accordance with Californai Code of Regulations Title 22, Division 12, Chapter 3, Section 101238(a) Buildings and Grounds is being cited on the attached LIC 809D.

An inspection and exit interview were completed with Director, Soto. The report was reviewed and discussed. Appeal Rights were discussed. Mr. Soto was provided copy of their appeal rights (lic 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received the the Regiona Office within 15 business days.

The Director, Soto was informed that the "Notice of Site Visit" must be posted for 30 consecutive days. The Notice of Site Visit must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
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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Document Has Been Signed on 04/21/2022 12:59 PM - It Cannot Be Edited

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-LINDBERGH
FACILITY NUMBER: 304270761

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2022
Section Cited

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101238(a) Buildings and Grounds. The childcare center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children;employees and visitors. This requirement was not met as evidenced
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by LPAs review of facilitiy records. Based on facility record review, it was discovered that outlet iln Rm 14, Rm19 and Kitchen Prep had a high level of lead. This poses a potential risk to the health of children 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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
LIC809 (FAS) - (06/04)
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