198019903-6-26-2019-33-CC-CGRN-BDHPSV-20190626113459

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019903
Report Date: 06/26/2019
Date Signed: 06/26/2019 11:35:05 AM

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 SCHOOL		FACILITY NUMBER:	198019903
ADMINISTRATOR:	LAURA MARINA CABRAL		FACILITY TYPE:	850
ADDRESS:	209 E MARIPOSA ST		TELEPHONE:	(626) 794-9564
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	20	CENSUS: 0	DATE:	06/26/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Rosa Balderrama		TIME COMPLETED:	11:45 AM

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) Crystal Green conducted an announced capacity increase inspection. Licensing staff met with Rosa Balderrama, Site Director, who provided a tour of the facility. The purpose for this inspection is to measure and inspect the proposed additional classroom and outdoor space for the preschool program. Pasadena Waldorf Preschool will operate Monday - Friday beginning from 8:00 am - 4:00 p.m. June thru August. Licensee will place the facility on inactive status September thru May. NOTE: Pasadena Waldorf (K-8th) operates on the same campus. The school is a private school which operates through a private school affidavit. There are no waivers on file as the preschool indoor space and yard will be exclusive to the preschool program. Their proposed program will use two classrooms. Measurements for the currently licensed areas has been obtained during the prelicensing inspection conducted on 06/08/2018. The licensee is requesting to add an additional classroom which will be called the Buttercup room. The director’s office will be used as the ill isolation room. There is a cot and restroom for ill children to use. Children attending will be signed in upon entry to the Lily Classroom. Parents will enter through the main entrance facing Mariposa and walk to the classroom which is located behind "The Big House". Children enrolled will nap. There are cots available. Linen will be taken home and washed by parents on a weekly basis or as needed. Continues Page 1 of 3.

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA WALDORF SCHOOL	FACILITY NUMBER: 198019903
	VISIT DATE: 06/26/2019

NARRATIVE

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Licensee will offer one morning and afternoon snack and shall ensure that snacks are age appropriate and follows Federal Food Guidelines. Snacks will be prepared in the main house. Children will bring their own lunches from home.

There is age-appropriate furniture and equipment in the classrooms. Cubbies are available for children's belonging. Children will have pitcher and cups so that they can drink water freely and as they wish. Age-appropriate sinks and toilets are available for children inside the classroom. There is dispensable soap and paper towels in the bathrooms.

The outdoor activity area is surrounded by a chain link fence. Per Site Director there will be water jugs and cups available for children to drink when outdoors. The outdoor play area consists of a gardening like environment which includes, hay, flowerbeds and wheel barrel for children to explore and play with. LPA observed 2 sections of the outdoor play area to contain an uneven pile of dirt with large holes which can cause a tripping hazard for children in care.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 Continues Page 2 of 3.

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

LIC809 (FAS) - (06/04)

Page: 2 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA WALDORF SCHOOL	FACILITY NUMBER: 198019903
	VISIT DATE: 06/26/2019

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The licensee has requested a capacity increase from 20 to 30. Measurements taken indoors and outdoors found that there is sufficient area for the requested capacity. A fire clearance has been approved for 30 preschool age children.

The following correction need to be made prior to submitting application for final approval. Correction will be due by 07/01/2019.

· Licensee will submit proof that the 2 dirt piles located in the outdoor play area have been fluffed to provide a stabled cushioned area.

An exit interview was conducted with Site Director. Appeal Rights discussed. License shall be mailed once processed.

Report Ends Page 3 of 3.

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3