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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414479
Report Date: 04/10/2024
Date Signed: 04/12/2024 11:28:54 AM

Document Has Been Signed on 04/12/2024 11:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:WESTSIDE WALDORF SCHOOL-SUNSET CAMPUSFACILITY NUMBER:
197414479
ADMINISTRATOR/
DIRECTOR:		JUDY PENROSEFACILITY TYPE:
850
ADDRESS:17310 SUNSET BOULEVARDTELEPHONE:
(310) 260-2708
CITY:PACIFIC PALISADESSTATE: CAZIP CODE:
90272
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 22DATE:
04/10/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Judy PenroseTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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This is an amendment of the original report created on 4/10/24. This is to amend the 809D page.

On 4/10/24 at 9:30AM, LPA Jeanine Lipsey met with Director Judy Penrose for the purpose of an unannounced Case Management - Deficiencies visit.

Upon entry, LPA Lipsey observed 22 children, between two classrooms, being supervised by four staff members.

Upon review of the employee roster, teacher Willaim Acher Biggs Chiropolos was found to have been working, residing or volunteering at the facility without a clearance transfer. Date of hire was 9/27/23. Director states that they would associate the staff member later today to become into compliance.

Based on today's observation, today's violation will be assessed a civil penalty. See attached LIC 809D.

On 4/10/24, a Civil Penalty of $500 was assessed due this violation. See LIC 809D

Exit interview conducted and report was reviewed with Director, Judy Penrose on 04/10/2024.  A copy of this report, along with Appeal Rights, were provided.  A Notice of Site Visit was given and must remain posted for 30 days.  LPA observed that the Notice of Site Visit was posted during the inspection.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2024
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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Document Has Been Signed on 04/12/2024 11:27 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/11/2024 02:41 PM


Created By: Jeanine Lipsey On 04/10/2024 at 03:46 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WESTSIDE WALDORF SCHOOL-SUNSET CAMPUS
FACILITY NUMBER: 197414479

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/10/2024
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance
All individuals subject to a criminal record review shall, prior to working, a licensed facility:Request a transfer of a criminal record clearance as specified ...
This requirement is not met by evidence by:
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Director will associate the staff member later today, 4/24/24 to become into compliance.
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 Based on record review, the licensee did not ensure William Acher Biggs Chiropolos (date of hire 9/27/23) was associated to the facility which poses a potenial health, safety, or personal rights risk to persons in care. A civil penalty of $500 has been assessed.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 04/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/10/2024


LIC809 (FAS) - (06/04)
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