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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370298
Report Date: 04/09/2025
Date Signed: 04/09/2025 11:43:30 AM

Document Has Been Signed on 04/09/2025 11:43 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:WALDORF SCHOOL OF ORANGE COUNTYFACILITY NUMBER:
304370298
ADMINISTRATOR/
DIRECTOR:		HOLLY RICHARDSFACILITY TYPE:
850
ADDRESS:2350 CANYON DRIVETELEPHONE:
(949) 574-7775
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 9DATE:
04/09/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Holly RichardsTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dean Thompson conducted an unannounced case management incident inspection in response to a self reported Unusual Incident dated 4/4/2025. LPA met with Director Holly Richards and toured the facility. LPA observed nine preschool age children with two preschool staff.

A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the visit, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

On 4/4/2025, a self reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported on 4/2/2025, child #1 (C1) climbed on top of a 3 foot shelf which tipped over and C1 hitting their head resulting in a goose egg (hematoma).

Based on the documents submitted, the shelf was not secured to the wall when the incident occurred on 4/2/2025. Sign in/sign out sheet on 4/2/2025, shows staff ratio at the time of incident was one teacher with nine preschool age children.

On 4/3/2025, the facility secured the shelf to the wall to prevent similar incidents.

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Nguyen K TranTELEPHONE: (714) 658-6048
Dean ThompsonTELEPHONE: (714) 287-0708
DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2025
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: WALDORF SCHOOL OF ORANGE COUNTY
FACILITY NUMBER: 304370298
VISIT DATE: 04/09/2025
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Based on information provided to the Orange Regional Office and directors statement on the self reported incident, it was determined the shelf was not bolted when the incident occurred, making it unsafe for children present.

The following violation Buildings and Grounds was revealed today and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, 101238(a). Please see the attached LIC 809D page.

Exit interview conducted and report was reviewed with Director Holly Richards.



A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/09/2025 11:43 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: WALDORF SCHOOL OF ORANGE COUNTY
FACILITY NUMBER: 304370298

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/09/2025
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement was not met by:
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On 4/3/2025, before school started, the shelf was bolted to the wall. Director stated she will go through the classrooms and secure shelving.
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Based on observation, documentation, and interview, the licensee did not comply with the section cited above. The shelf was not bolted when the incident occured, making it unsafe for children present, which poses/posed a potential health, safety or personal rights risk to persons 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.
Nguyen K TranTELEPHONE: (714) 658-6048
Dean ThompsonTELEPHONE: (714) 287-0708

DATE: 04/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2025

LIC809 (FAS) - (06/04)
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