<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343600289
Report Date: 06/27/2024
Date Signed: 07/05/2024 01:49:59 PM

Document Has Been Signed on 07/05/2024 01:49 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CATALYST KIDS - JOHN EHRHARDTFACILITY NUMBER:
343600289
ADMINISTRATOR/
DIRECTOR:		MARTINEZ-LEON, ANTOINETTEFACILITY TYPE:
840
ADDRESS:8900 OLD CREEK DRIVETELEPHONE:
(916) 684-1815
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 9DATE:
06/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Antoinette LeonTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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
This is an amended version of the original report created on 06/27/2024.

On 07/05/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a Case Management inspection regarding a water report. LPA arrived at the facility and was met by Director Antoinette Leon (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA observed 2 school aged children being supervised by 1 staff member. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.
LPA informed D1 that the facility was cited for a lead exceedance in April 2022, and the citation for a lead exceedance on 06/27/2024, was a duplicate citation. The deficiency was removed from license #343600289.

In the areas that were evaluated on 07/05/2024, no deficiencies were cited during today's inspection. An exit interview was conducted, and the report was reviewed with Director Leon. LPA provided Licensee Appeal Rights to D1. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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 2
Document Has Been Signed on 06/27/2024 02:38 PM - It Cannot Be Edited


Created By: Katy Velazquez On 06/27/2024 at 02:07 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CATALYST KIDS - JOHN EHRHARDT
FACILITY NUMBER: 343600289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
07/04/2024
Section Cited

101700.3(b)(1)

1
2
3
4
5
6
7
A result which values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement was not met as evidenced by: Adviro Water report revealed that the facility had elevated levels of lead in 1 water fountain.
1
2
3
4
5
6
7
During today's visit, LPA observed that the affected water outlet was not in use. D1 stated that filtered water is being served. D1 stated that the water outlet will be permanently removed. Deficiency will be cleared during visit.
8
9
10
11
12
13
14
The exceedance of lead in a water fountain poses/posed a potential health, safety or personal rights risk to persons in care.

8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
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:Karyn Guerra
LICENSING EVALUATOR NAME:Katy Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2