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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270761
Report Date: 09/15/2022
Date Signed: 09/15/2022 05:50:04 PM


Document Has Been Signed on 09/15/2022 05:50 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: 25DATE:
09/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Alejandra FigeroaTIME COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Castanon and Tran conducted an unannounced Case Management visit. LPA's met with Aljejandra Figeroa, Administrative Assistant to discuss the Lead Sampling Testing conducted on 08/25/22.

During the inspection, LPA's discovered that the initial test results in March 2022 showed outlet B (6.1ppb) in room 19, Outlet C (6.7ppb) in kitchen, and outlet L (5.8) in room 14. LPA Rivas and Duron had visited facility and cited for the three outlets on April 21, 2022. Facility had a Plan of Correction and contacted Adviro staff who came out and retested the three outlets, which were flushed for two weeks (8/8-8/19).

When Adviro staff returned on 7/13 and 9/2 to retest, the outlets were labeled differently because failed outlets had then passed, which was outlet B in room 19 and outlet C in kitchen also passed.

Outlet L is currently named Outlet B in room 14 (7.4ppb). LPA's observed boarded up with a sign stating not to use sink. Room 14 where outlet B is located is a storage room and is not in use. Director will keep LPA Castanon updated with outlet B and submit in writing the plan of action after consulting with Newport Mesa School District.

No deficiency was observed in the areas that were inspected, in California Code of Regulations, Title 22, Division 12 at the time of the visit.


End of Report
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Romelia M CastanonTELEPHONE: (714) 746-8565
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
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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