CATALYST KIDS-TRIDENT

Type B citation from complaint investigation - potential risk if not corrected

Type A citation from complaint investigation - immediate risk

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 01/30/2023 at 8:41 AM Licensing Program Analyst, Stella Gutierrez made an unannounced visit for the purpose of conducting an investigation regarding a self reported incident that took place on 01/27/2023. LPA was met by Maria Baes, Lead Teacher and stand in for director who was explained the reason for today's visit. LPA toured the facility inside and out. The direct,Magail Mesina showed up during the tour. Upon arrival LPA observed 11 children and 04 Staff providing care. A review of the Facility Personnel Report Summary conducted on 01/30/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. There was a self reported incident made to CCLD on 01/27/2023 that Child #1 was observed by Staff #2 outside on the pre-school playground unattended. During today's inspection On 01/30/2023 LPA interviewed 03 staff. It was revealed based on interviews and observation that on 01/27/2023 during the playground transition to indoors that Child #1 was left outside with adult supervision. On 01/30/2023 Staff #2 stated that while on the playground at 10:30 AM is was observed that child #1 was on the play structure alone. Staff #2 stated that they looked over the gate to see if there was another staff with Child #3 and Staff #3 stated that there was not staff and that classroom #22 door was closed as child #1 was outside alone with no adult supervision. Staff #1 who assist in Classroom #22 stated that they observed child #1 on the play structure during transition and Staff #3 (not present during LPAs visit today) asked Staff #1 to go inside and assist with washing hands while Staff #3 calls children in by their name. Page 1 of 2 SUPERVISORS NAME: Patricia Magana LICENSING EVALUATOR NAME: Stella Gutierrez LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 3 FACILITY NAME: CATALYST KIDS-TRIDENTFACILITY NUMBER: 304370213 VISIT DATE: 01/30/2023 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32On 01/30/2023 Staff #1 stated that a head count was not done once all the children entered classroom #22 which resulted a lack of supervision to ensure the safety of all children transitioning inside from outside was complete. Staff #1 also stated that it was only 5-10 seconds when Staff #3 realized that Child #1 was not in the classroom as Staff #3 entered with the child. On 01/30/2023 The director stated that training's are done each month on supervision or personal rights. The training consist of a module training. There is no training on head counts as the facility just bases the count on matching the name to the face of the children. On 01/30/2023 LPA reviewed attendance to be 14 children and 2 staff present on 01/27/2023 when normally there are 3-4 staff daily for classroom #22. It was determined that the facility within ratio and capacity in accordance to title 22 limitations and on the facility licensee. The playground is about 8-10 feet away from the door entrance of classroom #22. Based on LPAs observation and statements, it was revealed that child #1 was left outside on the playground alone on 01/27/2023 without any adult supervision. The child was left unattended for about 5-10 seconds as the Staff #3 did realize child #1 was not present in the classroom. During that 5-10 seconds Staff #2 brought the child #1 back into the classroom. The following violation for Responsibility for providing care and supervision was revealed today and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, 101229 (a)(1) . Please see the attached LIC 809D. Exit interview conducted and report was reviewed with the director, Magail Mesina. Appeal Rights and deficiencies were discussed. The facility representative was provided a 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 by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Failure to comp

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 01/30/2023 at 8:41 AM Licensing Program Analyst, Stella Gutierrez made an unannounced visit for the purpose of conducting an investigation regarding a self reported incident that took place on 01/27/2023. LPA was met by Maria Baes, Lead Teacher and stand in for director who was explained the reason for today's visit. LPA toured the facility inside and out. The direct,Magail Mesina showed up during the tour. Upon arrival LPA observed 11 children and 04 Staff providing care. A review of the Facility Personnel Report Summary conducted on 01/30/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. There was a self reported incident made to CCLD on 01/27/2023 that Child #1 was observed by Staff #2 outside on the pre-school playground unattended. During today's inspection On 01/30/2023 LPA interviewed 03 staff. It was revealed based on interviews and observation that on 01/27/2023 during the playground transition to indoors that Child #1 was left outside with adult supervision. On 01/30/2023 Staff #2 stated that while on the playground at 10:30 AM is was observed that child #1 was on the play structure alone. Staff #2 stated that they looked over the gate to see if there was another staff with Child #3 and Staff #3 stated that there was not staff and that classroom #22 door was closed as child #1 was outside alone with no adult supervision. Staff #1 who assist in Classroom #22 stated that they observed child #1 on the play structure during transition and Staff #3 (not present during LPAs visit today) asked Staff #1 to go inside and assist with washing hands while Staff #3 calls children in by their name. Page 1 of 2 SUPERVISORS NAME: Patricia Magana LICENSING EVALUATOR NAME: Stella Gutierrez LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 3 FACILITY NAME: CATALYST KIDS-TRIDENTFACILITY NUMBER: 304370213 VISIT DATE: 01/30/2023 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32On 01/30/2023 Staff #1 stated that a head count was not done once all the children entered classroom #22 which resulted a lack of supervision to ensure the safety of all children transitioning inside from outside was complete. Staff #1 also stated that it was only 5-10 seconds when Staff #3 realized that Child #1 was not in the classroom as Staff #3 entered with the child. On 01/30/2023 The director stated that training's are done each month on supervision or personal rights. The training consist of a module training. There is no training on head counts as the facility just bases the count on matching the name to the face of the children. On 01/30/2023 LPA reviewed attendance to be 14 children and 2 staff present on 01/27/2023 when normally there are 3-4 staff daily for classroom #22. It was determined that the facility within ratio and capacity in accordance to title 22 limitations and on the facility licensee. The playground is about 8-10 feet away from the door entrance of classroom #22. Based on LPAs observation and statements, it was revealed that child #1 was left outside on the playground alone on 01/27/2023 without any adult supervision. The child was left unattended for about 5-10 seconds as the Staff #3 did realize child #1 was not present in the classroom. During that 5-10 seconds Staff #2 brought the child #1 back into the classroom. The following violation for Responsibility for providing care and supervision was revealed today and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, 101229 (a)(1) . Please see the attached LIC 809D. Exit interview conducted and report was reviewed with the director, Magail Mesina. Appeal Rights and deficiencies were discussed. The facility representative was provided a 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 by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Failure to comp

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 01/30/2023 at 8:41 AM Licensing Program Analyst, Stella Gutierrez made an unannounced visit for the purpose of conducting an investigation regarding a self reported incident that took place on 01/27/2023. LPA was met by Maria Baes, Lead Teacher and stand in for director who was explained the reason for today's visit. LPA toured the facility inside and out. The direct,Magail Mesina showed up during the tour. Upon arrival LPA observed 11 children and 04 Staff providing care. A review of the Facility Personnel Report Summary conducted on 01/30/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. There was a self reported incident made to CCLD on 01/27/2023 that Child #1 was observed by Staff #2 outside on the pre-school playground unattended. During today's inspection On 01/30/2023 LPA interviewed 03 staff. It was revealed based on interviews and observation that on 01/27/2023 during the playground transition to indoors that Child #1 was left outside with adult supervision. On 01/30/2023 Staff #2 stated that while on the playground at 10:30 AM is was observed that child #1 was on the play structure alone. Staff #2 stated that they looked over the gate to see if there was another staff with Child #3 and Staff #3 stated that there was not staff and that classroom #22 door was closed as child #1 was outside alone with no adult supervision. Staff #1 who assist in Classroom #22 stated that they observed child #1 on the play structure during transition and Staff #3 (not present during LPAs visit today) asked Staff #1 to go inside and assist with washing hands while Staff #3 calls children in by their name. Page 1 of 2 SUPERVISORS NAME: Patricia Magana LICENSING EVALUATOR NAME: Stella Gutierrez LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 3 FACILITY NAME: CATALYST KIDS-TRIDENTFACILITY NUMBER: 304370213 VISIT DATE: 01/30/2023 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32On 01/30/2023 Staff #1 stated that a head count was not done once all the children entered classroom #22 which resulted a lack of supervision to ensure the safety of all children transitioning inside from outside was complete. Staff #1 also stated that it was only 5-10 seconds when Staff #3 realized that Child #1 was not in the classroom as Staff #3 entered with the child. On 01/30/2023 The director stated that training's are done each month on supervision or personal rights. The training consist of a module training. There is no training on head counts as the facility just bases the count on matching the name to the face of the children. On 01/30/2023 LPA reviewed attendance to be 14 children and 2 staff present on 01/27/2023 when normally there are 3-4 staff daily for classroom #22. It was determined that the facility within ratio and capacity in accordance to title 22 limitations and on the facility licensee. The playground is about 8-10 feet away from the door entrance of classroom #22. Based on LPAs observation and statements, it was revealed that child #1 was left outside on the playground alone on 01/27/2023 without any adult supervision. The child was left unattended for about 5-10 seconds as the Staff #3 did realize child #1 was not present in the classroom. During that 5-10 seconds Staff #2 brought the child #1 back into the classroom. The following violation for Responsibility for providing care and supervision was revealed today and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, 101229 (a)(1) . Please see the attached LIC 809D. Exit interview conducted and report was reviewed with the director, Magail Mesina. Appeal Rights and deficiencies were discussed. The facility representative was provided a 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 by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Failure to comp

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 01/30/2023 at 8:41 AM Licensing Program Analyst, Stella Gutierrez made an unannounced visit for the purpose of conducting an investigation regarding a self reported incident that took place on 01/27/2023. LPA was met by Maria Baes, Lead Teacher and stand in for director who was explained the reason for today's visit. LPA toured the facility inside and out. The direct,Magail Mesina showed up during the tour. Upon arrival LPA observed 11 children and 04 Staff providing care. A review of the Facility Personnel Report Summary conducted on 01/30/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. There was a self reported incident made to CCLD on 01/27/2023 that Child #1 was observed by Staff #2 outside on the pre-school playground unattended. During today's inspection On 01/30/2023 LPA interviewed 03 staff. It was revealed based on interviews and observation that on 01/27/2023 during the playground transition to indoors that Child #1 was left outside with adult supervision. On 01/30/2023 Staff #2 stated that while on the playground at 10:30 AM is was observed that child #1 was on the play structure alone. Staff #2 stated that they looked over the gate to see if there was another staff with Child #3 and Staff #3 stated that there was not staff and that classroom #22 door was closed as child #1 was outside alone with no adult supervision. Staff #1 who assist in Classroom #22 stated that they observed child #1 on the play structure during transition and Staff #3 (not present during LPAs visit today) asked Staff #1 to go inside and assist with washing hands while Staff #3 calls children in by their name. Page 1 of 2 SUPERVISORS NAME: Patricia Magana LICENSING EVALUATOR NAME: Stella Gutierrez LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 3 FACILITY NAME: CATALYST KIDS-TRIDENTFACILITY NUMBER: 304370213 VISIT DATE: 01/30/2023 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32On 01/30/2023 Staff #1 stated that a head count was not done once all the children entered classroom #22 which resulted a lack of supervision to ensure the safety of all children transitioning inside from outside was complete. Staff #1 also stated that it was only 5-10 seconds when Staff #3 realized that Child #1 was not in the classroom as Staff #3 entered with the child. On 01/30/2023 The director stated that training's are done each month on supervision or personal rights. The training consist of a module training. There is no training on head counts as the facility just bases the count on matching the name to the face of the children. On 01/30/2023 LPA reviewed attendance to be 14 children and 2 staff present on 01/27/2023 when normally there are 3-4 staff daily for classroom #22. It was determined that the facility within ratio and capacity in accordance to title 22 limitations and on the facility licensee. The playground is about 8-10 feet away from the door entrance of classroom #22. Based on LPAs observation and statements, it was revealed that child #1 was left outside on the playground alone on 01/27/2023 without any adult supervision. The child was left unattended for about 5-10 seconds as the Staff #3 did realize child #1 was not present in the classroom. During that 5-10 seconds Staff #2 brought the child #1 back into the classroom. The following violation for Responsibility for providing care and supervision was revealed today and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, 101229 (a)(1) . Please see the attached LIC 809D. Exit interview conducted and report was reviewed with the director, Magail Mesina. Appeal Rights and deficiencies were discussed. The facility representative was provided a 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 by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Failure to comp

Type B citation - potential risk if not corrected

Type B citation - potential risk if not corrected

Type B citation - potential risk if not corrected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25This 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 21 and 22. The sketch submitted was incorrectly marked. On the May sketch, Room 21 was listed as room 22. Outlets marked A, B,C, ARE IN ROOM 21. Outlets marked D,E,F Are in room 22. 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 21 outlets are listed as A, formerly B; A & C passed initial test. Room 22 outlets are B,C,D FORMERLY; D,E,F. In the July report outlet in Room 22 now listed as C is still exceeding levels, had flushed water for 5 weeks is scheduling new testing and will submit results. Plan is to stop using outlet if does not pass test. LPA viewed outlet which was made inaccessible via, bag and sign. Ms. Phillips has posted new report. 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)Page: 1 of 3 FACILITY NAME: CATALYST KIDS-TRIDENTFACILITY NUMBER: 304370213 VISIT DATE: 08/17/2022 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32Based 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 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 FACILITY NAME: CATALYST KIDS-TRIDENT FACILITY NUMBER: 304370213 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 08/17/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Request Denied Type B 08/31/2022 Section Cited CCR 101238 1 2 3 4 5 6 7101238 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:1 2 3 4 5 6 7Facility 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, 8 9 10 11 12 13 14Based on lab report analysis water from faucet B,D, E, F. These faucets samples taken on 05/06/2022 indicate levels of lead in exceedance.8 9 10 11 12 13 14PASS sinks readily available for the staff and children. Director stated that she will submit new restest results to LPA 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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: 08/1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25This 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 21 and 22. The sketch submitted was incorrectly marked. On the May sketch, Room 21 was listed as room 22. Outlets marked A, B,C, ARE IN ROOM 21. Outlets marked D,E,F Are in room 22. 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 21 outlets are listed as A, formerly B; A & C passed initial test. Room 22 outlets are B,C,D FORMERLY; D,E,F. In the July report outlet in Room 22 now listed as C is still exceeding levels, had flushed water for 5 weeks is scheduling new testing and will submit results. Plan is to stop using outlet if does not pass test. LPA viewed outlet which was made inaccessible via, bag and sign. Ms. Phillips has posted new report. 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)Page: 1 of 3 FACILITY NAME: CATALYST KIDS-TRIDENTFACILITY NUMBER: 304370213 VISIT DATE: 08/17/2022 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32Based 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 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 FACILITY NAME: CATALYST KIDS-TRIDENT FACILITY NUMBER: 304370213 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 08/17/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Request Denied Type B 08/31/2022 Section Cited CCR 101238 1 2 3 4 5 6 7101238 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:1 2 3 4 5 6 7Facility 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, 8 9 10 11 12 13 14Based on lab report analysis water from faucet B,D, E, F. These faucets samples taken on 05/06/2022 indicate levels of lead in exceedance.8 9 10 11 12 13 14PASS sinks readily available for the staff and children. Director stated that she will submit new restest results to LPA 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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: 08/1