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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270758
Report Date: 08/17/2022
Date Signed: 08/22/2022 11:47:12 AM

Document Has Been Signed on 08/22/2022 11:47 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-TRIDENTFACILITY NUMBER:
304270758
ADMINISTRATOR:PHILLIPS, DEBBIEFACILITY TYPE:
830
ADDRESS:1800 WEST BALL ROADTELEPHONE:
(714) 999-5632
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: DATE:
08/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:57 PM
MET WITH:Debbie Phillips, DirectorTIME COMPLETED:
03:30 PM
NARRATIVE
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This report supercedes the report dated 06/08/22. Licensing Program Analyst, Patricia Rivas conducted a virtual Case Management visit for the purpose to discuss the Lead Sampling Testing conducted on 05/06/2022.
This facility consists of rooms 23 and 24 at the time of the original visit room 23 was not in use.
The testing results were submitted under license# 304370213 entirely. The sketch submitted was incorrectly marked. On the May sketch, outlets marked G, H, I, J,K,L AND M were all marked in room 23. Outlets J, K, L M are in room 24. LPA's had noted at the time of the visit all outlets with high Action Level Exceedences(ALE) were made inaccessible, via plastic bag wrapped around the drinking faucet, tapped all around and a sign “do not use”, Facility is providing water bottles for drinking, portable sinks for hand washing, and using water from outlets that have passed lead test for cleaning.

Ms. Phillips reports that since beginning of COVID In 2020 the facility has stopped using faucets for drinking water used bottles of drinking water and also had been using paper plates, portable, sinks for hand washing and using water from outlets that have passed lead test for cleaning.

The facility has since re tested the outlets and received a report in July 2022. In the Report submitted for July 2022, outlets were renamed.
Room 23 outlets are E, F, AND G, formerly G,H and I.
Room 24 outlets are H,I,J,AND K, formerly J,K, L, M.

Ms. Phillips has posted new report.
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.

cont. page 2
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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: 08/17/2022
NARRATIVE
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Exit interview conducted with Deborah Phillips. The report was reviewed and discussed. Appeal Rights were discussed. Facility staff 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 Regional Office within 15 business days.

The staff 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.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/22/2022 11:47 AM - It Cannot Be Edited


Created By: Pat Rivas On 08/17/2022 at 04:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CATALYST KIDS-TRIDENT
FACILITY NUMBER: 304270758

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
08/31/2022
Section Cited
CCR
101238

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101238 Building and Grounds (a) The Child care 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 not met as evidence by:
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Facility staff followed Written Directives in PIN 21-21 CCP for lead water testing. Licensing Forms completed; 9275, 9276 and facility sketch submitted. Notification sent out to parents, water outlet flushed (not in use), conditioning for 3 weeks, water filter installed onto pipping,
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Based on lab report analysis water from faucet g, h, i, j, k,l, m. These faucets samples taken on 05/06/2022 indicate levels of lead in exceedance.
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PASS sinks readily available for the staff and children. Director stated that she will submit new restest results to LPA

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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 Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2022


LIC809 (FAS) - (06/04)
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