198010030-8-1-2022-33-CC-CGRN-CGVREF-20220801125727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010030
Report Date: 08/01/2022
Date Signed: 08/01/2022 01:00:02 PM

Document Has Been Signed on 08/01/2022 01:00 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	WAVERLY SCHOOL, THE		FACILITY NUMBER:	198010030
ADMINISTRATOR:	JOHN CERVANTES		FACILITY TYPE:	850
ADDRESS:	67 W. BELLEVUE		TELEPHONE:	(626) 792-5940
CITY:	PASADENA	STATE: CA	ZIP CODE:	91105
CAPACITY: 17	TOTAL ENROLLED CHILDREN: 17	CENSUS: 0	DATE:	08/01/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:22 AM
MET WITH:	Connie Rodarte- Director		TIME COMPLETED:	01:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Crystal Green conducted an unannounced case management licensee initiated inspection to inspect and measure facility for capacity increase determination. Facility is currently license for 17 preschoolers. Licensee is requesting to increase to 24 preschoolers. Due to COVID- 19 precautionary measures were taken, individuals present during inspection wore appropriate personal protective equipment. Licensing staff met with Connie Rodarte, Director. There is also a K-12 private school which operates on the same grounds. There are no shared areas between the preschool children and private school students. During the time of the inspection there were no preschool children present. Per Director, the preschool children are on summer break and will return 09/06/2022. LPA inspected all areas identified on the Facility Sketch. Children will have access to the classroom, restroom (located in the classroom) and outdoor play area. Restrooms were inspected for availability, good repair, area safety and sanitation. Individual storage space was available for each child located inside each classroom. Toys were observed to be clean and safe. There is telephone service, central air conditioning, lighting and ventilation available at the facility. There are smoke detectors and fire extinguishers located throughout the facility. Drinking water was observed available both indoors and outdoors. The main office will be used as the isolation area as well as staff offices if needed. Licensing staff was guided through the outdoor activity areas. The preschool outdoor area was observed to be physically separate from the private school outdoor area via a wooden fence. The play area is fully fenced. Outdoor playground equipment is in safe condition, free of sharp, lose or pointed parts. The play area has shade sails to provide shade. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. The play area has a sand box for children to play in as well as other toys. Report Continues Page 1 of 2.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: WAVERLY SCHOOL, THE	FACILITY NUMBER: 198010030
	VISIT DATE: 08/01/2022

NARRATIVE

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The facility offers an option for children to buy lunch from Choice Lunch a program that brings food to the facility. Children also have the option to bring their own lunches. The facility does provide A.M. and P.M. snack for the children. Staff and Children records were not reviewed during this inspection.

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.

At this time, the facility was observed to be operating in compliance with California Title 22 Regulations. An approved Fire Clearance has been received by the Department. Based on measurements obtained, the indoor capacity measured for 24 children and the outdoor capacity measured for 17 children. LPA consulted with the Director regarding information needed to submit an outdoor waiver request in order to obtain the capacity requested. LPA informed Director that waivers are not automatically granted and will need to be review by the department for final approval. LPA obtained pictures of the outdoor play areas during this inspection.

At 12:50, an exit interview was conducted with the Director, Connie Rodarte. A copy of this report and the Notice of Site Visit were provided to the Director.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Report Ends Page 2 of 2.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2