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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 553616388
Report Date: 07/16/2019
Date Signed: 07/16/2019 01:46:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:SIERRA WALDORF SCHOOLFACILITY NUMBER:
553616388
ADMINISTRATOR:GRAHAM-HINKEL, BRANDYFACILITY TYPE:
850
ADDRESS:19234 RAWHIDE ROADTELEPHONE:
(209) 984-0454
CITY:JAMESTOWNSTATE: CAZIP CODE:
95327
CAPACITY:15CENSUS: 0DATE:
07/16/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kim PendletonTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Justin Denton met with Kim Pendleton, School Administrator at Sierra Waldorf School, for a Case Management Inspection. Licensee had requested a change in capacity from 15 to 16 children. The program is currently located in Building F, which is fenced off from the main school campus. The program is not operating due to summer break.

There is an emergency exit door located at rear right-hand corner of the building. The exit door leads to the outside school campus. Licensee stated the back exit door will be used for emergency evacuation purposes only.

LPA observed hooks inside cubbies to the left of the entry for storage of children's personal belongings.

LPA observed a fire extinguisher on the wall to the right of the doorway that meets regulation.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

Report continues on C-Page
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
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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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: SIERRA WALDORF SCHOOL
FACILITY NUMBER: 553616388
VISIT DATE: 07/16/2019
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INDOOR ACTIVITY SPACE:
LPA inspected the classroom for the necessary space for the increased capacity. There is ample age-appropriate furniture and equipment. Napping materials are stored in a closed shelf when not in use. Drinking water is available in a water jug by the door of the classroom. There is one restroom area equipped with two toilets and one sink to support the requested capacity. LPA discussed 100% supervision of children utilizing the restroom. The total square footage is 601 square feet, which is unchanged from the previous visit on 9/12/18. This is sufficient for a capacity of 16 children.

OUTDOOR ACTIVITY SPACE:

The program will continue to use the outdoor play area as previously approved. LPA observed a drinking water jug in the shaded area near the building entrance. The outdoor play area is fenced and is equipped with age-appropriate equipment as follows: garden area and sandbox. There are shaded areas including trees and a building canopy.

Fire clearance approval has been obtained from the Fire Marshall. Per approval of LPA Justin Denton, the facility will be licensed for a capacity of 16 preschool age children on 7/22/19.

Notice of Site Visit was posted and an exit interview was conducted.

SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
LIC809 (FAS) - (06/04)
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