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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573601219
Report Date: 08/31/2022
Date Signed: 08/31/2022 04:51:34 PM

Document Has Been Signed on 08/31/2022 04:51 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CATALYST KIDS - DAVIS MIGRANTFACILITY NUMBER:
573601219
ADMINISTRATOR:CONTRERAS, BLANCAFACILITY TYPE:
850
ADDRESS:31150 COUNTY ROAD #105TELEPHONE:
(707) 678-4048
CITY:DIXONSTATE: CAZIP CODE:
95620
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
08/31/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Blanca ContrerasTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Chayntel Hunter and Lauren Scott met with Director Blanca Contreras for a Case Management inspection. The purpose of the inspection was to follow-up on a lead testing report dated 06/01/2022 which tested the water in the facility.

LPA was notified of the lead testing report on 06/02/2022 via email. The report revealed that one water outlets had elevated levels of lead. Director reported that the fountains had been marked as "closed" and were currently inaccessible for use. Director also stated the fountains had not been used since March 2020 when they were tapped off to be inaccessible for use due to COVID-19.

During today's inspection, LPA verified that the affected water outlets are not in use. Director stated that she is finished flushing the water outlets as they were re-tested for lead on 08/19/2022. During the visit LPA received test results that the water outlet had passed. Deficiency will be cleared during visit.

As a result of the water testing positive for lead, a deficiency was cited on a subsequent page, 809D. An exit interview was conducted and the report was reviewed with Director. A Notice of Site was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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 2
Document Has Been Signed on 08/31/2022 04:51 PM - It Cannot Be Edited


Created By: Chayntel Hunter On 08/31/2022 at 04:35 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 - DAVIS MIGRANT
FACILITY NUMBER: 573601219

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/30/2022
Section Cited

101700.3(b)(1)

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Lead Testing (b)(1) 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:
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During today's visit LPA observed that the affected water outlets are not in use. Director stated that once she was informed, she took immediate action. Re-testing took place on 08/19/2022. During the visit LPA received test results that the water outlet had passed. Deficiency will be cleared during visit.
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The water report dated 06/01/2022 revealed that the facility had elevated levels of lead in one water fountain. This is a potential health and safety risk to the 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:Justin L Denton
LICENSING EVALUATOR NAME:Chayntel Hunter
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022


LIC809 (FAS) - (06/04)
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