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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093615934
Report Date: 12/10/2019
Date Signed: 12/10/2019 03:59:30 PM

COMPREHENSIVE INSPECTION
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:CEDAR SPRINGS WALDORF SCHOOLFACILITY NUMBER:
093615934
ADMINISTRATOR:GUNASEKARA, VERONICAFACILITY TYPE:
850
ADDRESS:6029 GOLD MEADOWS ROADTELEPHONE:
(530) 642-9903
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY:60CENSUS: 20DATE:
12/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Veronica GunasekaraTIME COMPLETED:
04:10 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
Licensing Program Analyst (LPA) Kelly Ferrara met with Director Veronica Gunasekara for the purpose of an unannounced random annual inspection. The facility operates in rooms D4, D5, and C7. LPA toured the facility including all activity and classroom spaces, restrooms, and outdoor play area. Appropriate ratio and care and supervision were observed during today's inspection. Census included 20 preschool children being supervised by three staff. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday from 8:30 AM- 12 PM with the option of staying in extended care until 5:30 PM.

Classrooms all appeared clean including the carpets and floor. Playground equipment and surfaces were inspected and are in good condition. However, LPA observed that there was only dirt under the climbing structure and swings instead of resilient material to absorb a fall. Uncontaminated drinking water was readily available to children both indoors and outdoors. Bathrooms were clean and all sinks and toilets were in operating condition. There are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. Menus were posted for snack and the facility does not supply lunch. All required licensing documentation was posted for parental review. LPA observed a clipboard where parents are signing their children in and out of the center.

A sample of children and staff files were reviewed. Each child's file had the required licensing documentation. Staff files contained all required documentation, including proof of immunizations and Mandated Reporter training certification. LPA advised that this must be completed every two years. LPA reviewed transcripts and the teachers were qualified. At least one staff had a current Pediatric CPR and First Aid certification that expires in August 2020. LPA observed a current children's roster and fire drill log with the last drill conducted in September 2019.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: CEDAR SPRINGS WALDORF SCHOOL
FACILITY NUMBER: 093615934
VISIT DATE: 12/10/2019
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
32
Incidental Medical Services (IMS) policy was discussed with the Director. Each classroom was equipped with First Aid equipment. For additional IMS information, director was advised to see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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.

The facility evaluation report was reviewed and discussed with the Director. Director was encouraged to the visit the department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers. LPA gave the Effects of Lead Exposure brochure and discussed with the Director Assembly Bill 2370, which will require licensed Child Care Facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1st, 2020 and must be conducted every five years.

A notice of site visit was provided and should remain posted for a period of 30 days for parental review.

There was one Type B citation issued based on today's inspection.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CEDAR SPRINGS WALDORF SCHOOL
FACILITY NUMBER: 093615934
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

1
2
3
4
5
6
7
(e) As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.This requirement was not met as evidenced by: LPA observed climbing structure and swings on the playground with only dirt below them. This is a potential
8
9
10
11
12
13
14
health and safety risk to children in care.
8
9
10
11
12
13
14

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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3