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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620607
Report Date: 04/05/2022
Date Signed: 04/06/2022 07:05:13 AM

Document Has Been Signed on 04/06/2022 07:05 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CATALYST KIDS - VALLEY VIEWFACILITY NUMBER:
313620607
ADMINISTRATOR:MOTT, RICHELLEFACILITY TYPE:
840
ADDRESS:3000 CREST DRIVETELEPHONE:
(916) 435-4844
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 11DATE:
04/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Richelle HudsonTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jeremey McClain met with Site Supervisor Richelle Hudson for an unannounced Case Management Inspection. LPA observed care and observation of 11 children by three staff.

The purpose of today’s inspection was to follow up regarding water sampling that indicated Action Level Exceedance (ALE) for a drinking fountain that was tested for lead levels on 02/26/2022. On 03/08/2022 the facility was notified that water levels were in exceedance of 5 parts per billion in the drinking fountain that was tested.

Since notification, the water fountain has been taped off not allowed for use. A request has been made to school district to replace the drinking fountain, but the program plans to replace the fountain the fountain if the school district cannot. After replacement the water fountain will be replaced.

Alternative drinking water has been provided through the facility through store bought water and a water cooler, as well as children bringing their own water bottles.

LPA informed Site Supervisor that Grant funding for testing and remediation is available referenced from Provider Information Notice (PIN) 21-04-CCP.

Deficiencies are cited on the following page of the report and pose a potential threat to the health and safety of children in care if not corrected.

LPA reviewed this report with the Site Supervisor and conducted an exit interview. A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2022
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 04/06/2022 07:05 AM - It Cannot Be Edited


Created By: Jeremey McClain On 04/05/2022 at 02:46 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CATALYST KIDS - VALLEY VIEW
FACILITY NUMBER: 313620607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2022
Section Cited
CCR
101238(a)

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Building and Grounds. 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 was not as evidenced by lead test results received by CCLD on 03/14/2022. On 03/28/2022, the facility was notified that a drinking fountain
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The drinking fountain has been taped off to prevent usage by children in care. Alternative drinking water has been provided to children in care through store bought water and children's own water bottles. The facility plans to replace the drinking fountain and have it retested. Proof of a new drinking fountain or a test indicating levels of 5 ppb or less will be sent to LPA by
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tested on 02/26/2022 had lead levels exceeding 5 parts per billion(ppb). This poses a potential risk to the health and safety of children in care.
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the POC due date of 05/05/2022.

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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:Keven Peters
LICENSING EVALUATOR NAME:Jeremey McClain
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2022


LIC809 (FAS) - (06/04)
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