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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019903
Report Date: 07/14/2021
Date Signed: 07/14/2021 01:06:39 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:
198019903
ADMINISTRATOR:LAURA MARINA CABRALFACILITY TYPE:
850
ADDRESS:209 E MARIPOSA STTELEPHONE:
(626) 794-9564
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY:50CENSUS: 13DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Laura CabralTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Crystal Green conducted an unannounced required annual inspection. LPA met with designated facility Director, Laura Cabral and Site Supervisor, Rosa Balderrama. Due to COVID- 19 precautionary measures were taken, individuals present during inspection wore appropriate personal protective equipment. Facility was observed to be adhering to local public health guidelines. Pasadena Waldorf Preschool will operate Monday - Friday beginning from 9:00 am - 3:15 p.m. June thru August. 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.

At approximately 11:15 AM LPA Green began inspection of the preschool program. All areas identified on the facility sketch were inspected. This facility consists of (3) classrooms called Lily Room, Buttercup Rooms, and the Rose Room. LPA observed the Lily Room to be the only classroom in use during this inspection. LPA observed 13 children with 2 staff in the outdoor play area. Teacher-child ratios were observed to be in accordance with Title 22 regulations. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times.

Due to COVID- 19 precautionary measures, Director states that each classroom will have their own drop off times to limit contact with other preschool children and temperature checks will be conducted prior to entry. Children attending will be signed in upon entry to the main office area. Children will remain in that area with their assign classroom until all children are accounted for. Per Director, parents provide snacks and lunches for their child. Children bring their own drinking cup for water due to COVID-19 precautionary measure.

LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. Report Continues Page 1 of 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

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

DATE: 07/06/2021
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 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: 07/14/2021
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All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. The office is used as an isolation area. Per Director, the facility also uses the buttercup room as an isolation area.

There is drinking water available in the classroom via filtered tap water and water cooler jug. LPA observed the children to have their own personal sippy cups while outdoors. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Storage areas for poisons are locked. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The licensee takes measures to keep the facility free of flies, other insects and rodents.

The outdoor activity area was observed to be surrounded by a chain link fence. There is adequate shade provided in the outdoor play area via trees and a canopy. LPA observed the children to also use the patio deck as shade. There is a water jug and cups available for children to drink when outdoors. Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards.

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. Staff Records were reviewed to ensure that a health screening report is on file. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed.



This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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 Report Continues Page 2 of 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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: 07/14/2021
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At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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.



Exit interview was conducted with Director, Appeal Rights and Procedures explained and provided.

Report Ends Page 3 of 3.

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3