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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010030
Report Date: 05/22/2025
Date Signed: 05/27/2025 11:49:11 AM

Document Has Been Signed on 05/27/2025 11:49 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WAVERLY SCHOOL, THEFACILITY NUMBER:
198010030
ADMINISTRATOR/
DIRECTOR:		CONNIE RODARTEFACILITY TYPE:
850
ADDRESS:67 W. BELLEVUETELEPHONE:
(626) 792-5940
CITY:PASADENASTATE: CAZIP CODE:
91105
CAPACITY: 24TOTAL ENROLLED CHILDREN: 20CENSUS: 16DATE:
05/22/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Director Connie RodarteTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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 On 5/22/25 at 1:30pm, Licensing Program (LPA) Stephanie Li conducted an unannounced annual inspection. Upon arrival, LPA met with Director Connie Rodarte, who led LPA on a tour of the facility. This is a preschool license. There are currently 20 children enrolled. Census was taken. There were 16 children and 4 teachers. Hours of operation are Monday-Friday from 8:00am-6:00pm.

All areas identified on the Facility Sketch were inspected. The preschool facility consists of 1 classroom, 1 bathroom, 1 playground, and nurses office. The following was observed: Busy bats room have 16 children and 4 teachers. Teacher-child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. All children were observed to be under active/visual supervision of a teacher during the tour.

Licensing staff observed disinfectants, cleaning solutions, medication and other items that are dangerous to children were not accessible to children. Classroom furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. Children nap on mats. Sheets are washed on site by staff and blankets brought home by parents to wash. Storage for children's belongings were inspected. All toilets and washing facilities were inspected for safe and sanitary operating conditions. First Aid supplies are available and complete. The nurses office is used as the sick area for an ill child to rest. LPA advised that an ill child could use the staff bathroom and should not use the restroom used by all children. There is a staff bathroom available near the nurses office for an ill child to use. Drinking water is available and provided through water fountain in the elementary school hallway. Per director, teachers have scheduled water bottle checks and refill as needed and encourage children to hydrate. Parents pack snack and lunch from home. Nurse keeps emergency snacks in case children don't have enough food.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WAVERLY SCHOOL, THE
FACILITY NUMBER: 198010030
VISIT DATE: 05/22/2025
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Licensing staff observed all required forms/publications to be posted on the parent board near the preschool room entrance. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Per Director, sometimes children will eat outdoors. LPA advised that outdoor trash can used to discard food shall have tight fitting lids per Health and safety regulations. The facility was observed to be free of flies, other insects, and rodents.

Licensing staff observed the required 2A10BC fire extinguisher indicates fully charged and was serviced on 07/19/2024 on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Facility has a functioning carbon monoxide and smoke detector that meets statutory requirements and is hardwired. Per Director, there are no weapons, firearms. LPA did not observe any bodies of water on the premises. Per school log, the last disaster drill was conducted on 04/30/25.

Licensing staff observed the outdoor play area. The playgrounds equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA did observe broken rusty metal toy truck beds, which is a hazard. LPA advised director to remove all rusty toy trucks until they can be repaired or replaced. Rusty toy trucks were removed during today's visit. There is adequate shade in the play yard. Drinking water is readily available outdoors.

Sign in and out sheets were checked for parents full signatures. Children's roster was available for review. Staff and children’s records were reviewed and documented on LIC857 and LIC859. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Incidental Medical Services (IMS) is currently being provided. 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

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WAVERLY SCHOOL, THE
FACILITY NUMBER: 198010030
VISIT DATE: 05/22/2025
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LPA observed Epi-pen and inhaler in nurse's office. Per Director, parents stated that child does not officially need epi-pen anymore but would like the facility to hold onto it for any unexpected allergy incidents. Facility has allergy/medication forms in their digital system 'Magnus Health'. Per director, family was still in the process of exploring child's allergies. LPA advised director to request statement in writing from parents regarding the eip-pen request and keep in bin with epi-pen.

Facility was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Facility completed lead testing in 11/2023. LPA advised to refer to lead test results for retesting date.

Teacher was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WAVERLY SCHOOL, THE
FACILITY NUMBER: 198010030
VISIT DATE: 05/22/2025
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At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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.

Exit interview conducted, report was reviewed, and appeal rights were given to Director Connie Rodarte.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC809 (FAS) - (06/04)
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