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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018862
Report Date: 11/22/2019
Date Signed: 11/22/2019 04:56:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PASADENA WALDORF SCHOOLFACILITY NUMBER:
198018862
ADMINISTRATOR:LAURA CABRALFACILITY TYPE:
850
ADDRESS:536 E. MENDOCINO ST.TELEPHONE:
(626) 765-9978
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY:48CENSUS: 15DATE:
11/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Laura CabralTIME COMPLETED:
05:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Crystal Green and Licensing Program Manager (LPM) Christina Gabelman conducted an unannounced annual inspection. Upon arrival, Licensing staff met with Lauren Valencia, Office Assistant, until Director, Laura Cabral arrived shortly after. Licensing staff was guided on a tour of the facility. This is a preschool program licensed for (48) preschoolers. Facility operation hours are Monday to Friday from 8:30 AM to 3:30 PM.

There is a total of (2) preschool classrooms; Poppy and Sunflower classrooms. Upon arrival, Licensing staff observed the (15) napping preschoolers with (2) staff members (teachers assistants) in the Poppy classroom. There were no children present in the Sunflower classroom per Office Assistant due to the low number of children they take their naps in one classroom. Staff names were recorded. All preschoolers were observed by LPA to be under visual supervision of a teacher at all times. The facility was observed to be meeting the required teacher-child ratio. Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. Upon review of the sign in and out sheets, there were only 4 children signed in for the Poppy classroom and 6 signed in for the Sunflower classroom, but there were 15 children present during this inspection.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings which is located outside of the classroom. Licensing staff observed the children jackets to be touching. Napping equipment (cots) are store in a corner of the classroom. Linens are washed weekly by the parents. The ill isolation area is at the director's office and a cot is available. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. LPAs observed the smoke detector system throughout the facility. There is drinking water available via water pitch and cups so that the children may drink freely.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA WALDORF SCHOOL
FACILITY NUMBER: 198018862
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/29/2019
Section Cited

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Sign in and Sign out- The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement was not met as evidence by upon review of the sign in and out sheets, there were only 4 children sign in for the Poppy classroom and 6 sign in for the
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Sunflower classroom, but there were 15 children present during this inspection. This poses a potential risk for the health and saftey of the children in care.
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Type B
01/01/2020
Section Cited

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Mandated Reporter Training- On January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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This requirement was not met as evidence by during staff files review it was observed that staff #2 and staff #4 was missing the Mandated Reporter Training Certificate. This poses an potential risk to the Health and Safety of 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: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PASADENA WALDORF SCHOOL
FACILITY NUMBER: 198018862
VISIT DATE: 11/22/2019
NARRATIVE
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Outdoor playground equipment is in good condition, free of sharp, or pointed parts. The surface of the outdoor activity space is maintained in a safe and is free of hazards. All areas around or under climbing equipment and similar equipment cushioned with material to absorbs a fall. There is adequate shade provided in the play yard via trees. LPAs observed drinking cups available outdoors. Per Director, a water pitcher is brought outdoors so that the children may drink freely. Licensing staff observed chickens with a chicken coop located on the facility ground. Per Director, waivers are signed by parents and was observed in the children's records.

This facility provides AM and PM snacks. Lunch is brought in by parents. Food storage areas are kept clean and are free of litter, rubbish and rodents and/or any other vermin. Food preparation areas were inspected for cleanliness. Menus were observed to be posted and available for review.

This facility provides Incidental Medical Services- IMS. Per Director, there are no children currently enrolled that require IMS. For IMS information 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

Staff Records was reviewed to ensure that each file contains a Personnel Record, Qualifications and verification of CPR/First Aid and health preventative practices documentation. During staff files review it was observed that staff #2 and staff #4 was missing the Mandated Reporter Training Certificate. Staff #1 and Staff #2 whom observed alone with the napping children has an expired CPR certification on file. Children’s Records was reviewed to ensure that each child has an Emergency and Identification form on file. Children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 11/14/2019.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA WALDORF SCHOOL
FACILITY NUMBER: 198018862
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
11/25/2019
Section Cited

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CPR- At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.
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This requirement was not met as evidence by Staff #1 and Staff #2 whom observed alone with the napping children has an expired CPR certification on file. This poses an immediate risk to the Health and Safety of 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: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PASADENA WALDORF SCHOOL
FACILITY NUMBER: 198018862
VISIT DATE: 11/22/2019
NARRATIVE
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Exit interview was conducted with Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5