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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270835
Report Date: 05/19/2022
Date Signed: 05/19/2022 10:18:43 AM


Document Has Been Signed on 05/19/2022 10:18 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-LADERAFACILITY NUMBER:
304270835
ADMINISTRATOR:HUND, ALYSHAFACILITY TYPE:
840
ADDRESS:2515 RAWLINGS WAYTELEPHONE:
(714) 505-8098
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:70CENSUS: 17DATE:
05/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Alysha Hund - DirectorTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst Carmen Odom conducted an unannounced Case Management visit. LPA met with Director, Alysha Hund to discuss the Lead Sampling Testing conducted on 04/23/22. Director was advised on 05/16/22 that the Lead Sample Report was to be posted. LPA confirmed that Director had posted the Lead Sample Report.

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”. The outlet is in room#2 temporarily closed off until the they replace the drinking faucet. Source of drinking water is 6 “Brita” water pitchers that have built-in filters, the pitchers are refilled from outlets that tested negative for Lead. Director stated they have ordered the replacement faucet, when the replacement faucet arrives they will have it retested for Lead.

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

Exit interview conducted and report was reviewed with the facility representative Alysha Hund. A notice of site visit was given and must remain posted for 30 days.



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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2022
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 05/19/2022 10:18 AM - 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-LADERA
FACILITY NUMBER: 304270835

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
05/19/2022
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 by:
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Based on facility Lead sampling tests it was discovered that drinking fountain/outlet in Rm 2 had 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2022
LIC809 (FAS) - (06/04)
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