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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423057
Report Date: 06/07/2021
Date Signed: 06/07/2021 12:02:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:BERKELEY ROSE WALDORF SCHOOLFACILITY NUMBER:
013423057
ADMINISTRATOR:COLEMAN, MEGANFACILITY TYPE:
850
ADDRESS:2515 HILLEGASS AVETELEPHONE:
(510) 859-7679
CITY:BERKELEYSTATE: CAZIP CODE:
94704
CAPACITY:14CENSUS: 11DATE:
06/07/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jessica PrenticeTIME COMPLETED:
12:15 PM
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On 06/7/21 at 10:00am, Licensing Program Manager (LPM) Mayla Mendoza and Licensing Program Analysts (LPAs) Melissa Domantay and Melissa Guirit arrived at the facility for an announced case management inspection. LPA met with Jessica Prentice, the director. The normal hours of operation are Monday-Friday 8:00am-5:30pm. An application was received to add one additional, The Rosebud Classroom and play yard with an increase of capacity. There are no changes to the bathrooms that were previously licensed. Outdoor space that was previously licensed will no longer be used. LPM and LPAs toured the new Rosebud classroom, which has one sink and new play yard to conduct a health and safety inspection, and completed the following measurements:
INDOORS: 1069.31 square feet = 30 children
OUTDOORS: 2506.50 square feet = 33 children
All other indoor and outdoor measurements remain the same. A fire clearance was received from the Berkeley Fire Department on 10/26/20. Fire department approved for 13 children in Marigold Room and 11 children in the Rosebud Room.

The next door home was a previously licensed home, will be off limits to children, only attached bathroom on the side will be used by children, and bathroom and kitchen inside home will be used by Staff.
LPM and LPAs observed that there is sufficient heating, lighting and ventilation in the classrooms, and the classroom floors and surfaces are clean and free of hazards. The rooms have an ample supply of age appropriate furniture, toys and equipment which appear to be in good condition. LPM and LPAs did not observe any bodies of water, hazardous items or toxins that would be accessible to children. LPM and LPAs observed operating sinks and covered waste cans. The rooms are equipped with fully charged 3A40BC fire extinguishers, carbon monoxide detectors and centralized smoke detection systems. The facility has a working telephone and first aid supplies.

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SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Melissa DomantayTELEPHONE: 510-725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: BERKELEY ROSE WALDORF SCHOOL
FACILITY NUMBER: 013423057
VISIT DATE: 06/07/2021
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The Marigold Classroom, new Rosebud classroom, play yard, and license for a capacity of 24 children will be made part of the license, effective today 06/7/21, and can be used when the facility is ready. There are no deficiencies being cited today. This report will remain on file for 3 years. A Notice of Site inspection was provided to the director, and an exit interview was conducted

Incidental Medical Services (IMS) policy was discussed. LPA discussed the need to create a Plan of Operation for providing Incidental Medical Services, and the need to additionally have a specified plan for each child.

The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.


No deficiencies observed at this visit. A Notice of Site visit was given and facility was reminded that it is required to be posted for 30 days. Exit interview conducted, appeal rights provided, and a copy of this report was left with Director Jessica Prentice.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Melissa DomantayTELEPHONE: 510-725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
LIC809 (FAS) - (06/04)
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