573615250-7-8-2021-53-CC-ASIA-C4QPNG-20210708112755

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573615250
Report Date: 07/08/2021
Date Signed: 07/08/2021 11:28:07 AM

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:	DAVIS WALDORF SCHOOL		FACILITY NUMBER:	573615250
ADMINISTRATOR:	BREWER, KELLY		FACILITY TYPE:	850
ADDRESS:	3100 SYCAMORE LANE		TELEPHONE:	(530) 753-1651
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY:	75	CENSUS: 19	DATE:	07/08/2021
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Director, Jennifer Slater		TIME COMPLETED:	12:15 PM

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Licensing Program Analyst (LPA) Amy Silva met with Director, Jennifer Slater for the purpose of an unannounced annual random inspection. The school is currently operating June Bug Summer Camp.. Facility hours of operation during Summer Camp are Monday through Friday from 8:00 AM to 4:00 PM. The Summer Camp will end on August 20, 2021. School will resume on September 8, 2021.

LPA toured all activity and classroom space, restrooms, kitchen, and an outdoor play area. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Director stated there are no poisons on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and storage containers with solid waste have tight-fitting covers. Program provides morning snack and parents provide lunches.

Drinking water was readily available to children both indoors and outdoors. LPA observed two functional water fountains outside. LPA observed full legal signatures while reviewing the sign in and sign out sheet. Playground equipment and surfaces are free of loose or sharp parts. There is a sufficient amount of bark beneath the climbing structure. There are shaded areas supplied by overhangs, trees, and canopies.

Report continues on 809-C.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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: DAVIS WALDORF SCHOOL	FACILITY NUMBER: 573615250
	VISIT DATE: 07/08/2021

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Four staff and four children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member employed has current Pediatric CPR and First Aid certification (exp. 8/18/22). All staff currently employed with the facility have a criminal record clearance, health screening report, Mandated Reporter training certificates, and documentation of the educational background, training, and/or experience. LPA reminded Director that 100% supervision is required at all times, including in the bathroom. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. LPA reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the Director or an employee acting in the Director's absence must be reported to Department within ten working days.

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.

LPA verified the annual fees are current.

This facility evaluation report was reviewed and discussed with Director. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the inspection.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC809 (FAS) - (06/04)

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