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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010030
Report Date: 05/23/2023
Date Signed: 05/23/2023 02:12:32 PM

Document Has Been Signed on 05/23/2023 02:12 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, THEFACILITY NUMBER:
198010030
ADMINISTRATOR:JOHN CERVANTESFACILITY TYPE:
850
ADDRESS:67 W. BELLEVUETELEPHONE:
(626) 792-5940
CITY:PASADENASTATE: CAZIP CODE:
91105
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 18DATE:
05/23/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:TIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Crystal Green conducted an unannounced case management licensee- initiated inspection to inspect and measure. LPA met with Elementary School Director, Molly Geller also present was Preschool Director, Connie Rodarte. The Licensee also has a K-12 private school which operates on the same grounds. There are no shared areas between the preschool and private school.

This facility is currently licensed to care for 24 preschoolers. The facility was granted a waiver to use the preschool playground on a staggered play schedule due to the outdoor space measuring for a capacity of 17. Licensee has since expanded the outdoor space to include additional square footage and also installed a fencing around the play area. Licensee has requested to have the preschool outdoor space remeasured in order to increase the number of children allow outdoor.

During this inspection, LPA inspected the outdoor play area and obtained measurements. The outdoor play equipment was observed to be in good condition, free of sharp, lose or pointed parts. Outdoor equipment was observed to be age appropriate. There is adequate shade in the outdoor play area. LPA observed there to be cushioning material available in areas around and/or under climbing equipment to absorb a fall. LPA did not observe any violations or hazards outdoors. LPA observed drinking water to be accessible to children in care via (2) sinks located in the playarea with drinking water dispenser.

Based on the measurements obtained today, the facility is allowed to have (24) children utilizing the outdoor space at a time. The waiver granting use of the outdoor space on a staggered schedule is no longer needed.

Exit interview conducted and report was reviewed with the Preschool Director. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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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