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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215049
Report Date: 10/15/2020
Date Signed: 10/15/2020 01:16:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:WALDORF SCHOOL OF SANTA BARBARA, THEFACILITY NUMBER:
426215049
ADMINISTRATOR:CAROLYN KASTERFACILITY TYPE:
850
ADDRESS:7421 MIRANO DRIVETELEPHONE:
(805) 967-6656
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:60CENSUS: 3DATE:
10/15/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Carolyn KasterTIME COMPLETED:
12:15 PM
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On 10/15/20 at 11:45am, Licensing Program Analyst (LPAs) Ruth Gull conducted a CASE MANAGEMENT tele-inspection via FaceTime (due to COVID-19 State of Emergency) with Director Carolyn Kaster in order to discuss a Confirmation of Removal for Jeffrey E. Burt. A virtual tour of the center was conducted based on LPA's directions. There were 3 children present with 2 teachers on the playground.

On 09/21/20, Director Kaster submitted an LIC 300A Confirmation of Removal letter to Community Care Licensing certifying that Jeffrey E. Burt had been removed from the facility on 09/17/20.

Based on evidence obtained during today’s inspection, the LPA has verified that Jeffrey E. Burt is not present, nor currently employed at the facility. On 09/21/20, Director Kaster submitted a request to Community Care Licensing to disassociate Jeffrey E. Burt from the facility. Director to submit an updated LIC 500.

Verification of removal is complete.

Exit interview was conducted with Carolyn Kaster via tele-inspection. This report will be sent to the Director via email with a read receipt or confirmation of receipt of email, which will act as the Director's signature. The Notice of Site Visit (LIC9213) will also be e-mailed to the Director. The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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