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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313974
Report Date: 04/11/2023
Date Signed: 04/11/2023 01:01:52 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/02/2023 and conducted by Evaluator Patricia Duron
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230202143803
FACILITY NAME:WALDMAN, CINDYFACILITY NUMBER:
304313974
ADMINISTRATOR:WALDMAN, CINDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 505-3559
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:14CENSUS: 9DATE:
04/11/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:CIndy Waldman, Licensee TIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Facility fence is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Duron conducted an unannounced complaint visit to deliver the complaint findings. LPA met with Licensee Cindy Waldman. Census was taken. The overall census observed was 2 staff with 2 parent volunteers and 9 preschool children. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 2/2/23 a complaint was filed with the Licensing office stating facility fence is in disrepair. RP stated that they knocked the fence over and RP has 4x4’s holding it up.

During the course of investigation, LPA interviewed 2 staff members, and 4 parents, and reviewed records.
During the initial inspection dated 2/9/23 LPAs Duron and Thompson observed wood fence leaning over on some areas of the fence. On 3/28/23 LPA Duron inspected fence and observed the fence to be in disrepair due to nails on fence being exposed.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 06-CC-20230202143803
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: WALDMAN, CINDY
FACILITY NUMBER: 304313974
VISIT DATE: 04/11/2023
NARRATIVE
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LPA Duron interviewed one volunteer parent at the facility, and contacted five parents by phone and was able to interview three parents. All interviewed parents stated they did not have any concern with facility.

Based on LPA’s interviews, observations and reviewing records, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1 Section Section 102417 Operation of a Family Child Care (g)The home shall be free from defects or conditions which might endanger a child. Please refer to attached 9099D for documentation of deficiencies. Please refer to attached 9099D for documentation of deficiencies.

This requirement is not met as evidence by: Based on LPA’s observations of fence having nails exposed, which poses a potential health risk to the children in care.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were provided. The facility representative was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. Any proposed changes to the physical plant, including telephone number, shall be immediately reported to the Department.



The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.




SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 06-CC-20230202143803
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: WALDMAN, CINDY
FACILITY NUMBER: 304313974
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2023
Section Cited
CCR
102417
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102417 Operation of a Family Child Care (g)The home shall be free from defects or conditions which might endanger a child.
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Licensee's Plan of Correction (POC) is to repair fence where nails are exposed. Licensee will call Gate specialist/repairer and schedule an appointment to have her fence repaired by April 28, 2023.
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This requirement is not met as evidence by: Based on LPA’s observations of fence having nails exposed. This action poses an potential risk to the health and safety to the child in care.

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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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5