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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615250
Report Date: 09/07/2022
Date Signed: 09/07/2022 01:50:06 PM


Document Has Been Signed on 09/07/2022 01:50 PM - It Cannot Be Edited

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 SCHOOLFACILITY NUMBER:
573615250
ADMINISTRATOR:BREWER, KELLYFACILITY TYPE:
850
ADDRESS:3100 SYCAMORE LANETELEPHONE:
(530) 753-1651
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:75CENSUS: 0DATE:
09/07/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jennifer SlaterTIME COMPLETED:
02:30 PM
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Application Specialist (AS) Alecia Sifuentes met with Director, Jennifer Slater for the purpose of an announced change of capacity case management inspection. Licensee requests to serve 90 preschool children from 2 years to entry into first grade. The program operates Monday through Friday from 8:00 a.m. to 5:30 p.m. The fire clearance was granted and received on 09/07/2022.

INDOOR ACTIVITY SPACE:
There are four classrooms, Morning Glory, Climbing Rose, Lavender room, and Golden Poppy room. AS observed a sufficient amount of equipment, toys, tables, chairs, nap mats, and cubbies. AS measured all four classrooms. The total classroom space contains a total of 3,154 square feet, which will accommodate Licensee's request for 90 preschool children. There are 7 toilets and 11 sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. AS used current outdoor measurements. The outdoor play area contains a total of 12,333 square feet, which will accommodate Licensee’s requested for 90 preschool children.

Report continues on LIC809-C.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
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: 09/07/2022
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Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Exit interview conducted and report was reviewed with the Director, Jennifer Slater.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Effective today, 9/7/2022, AS will approve the change of capacity.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC809 (FAS) - (06/04)
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