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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624040
Report Date: 10/15/2021
Date Signed: 10/15/2021 01:24:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:SACRAMENTO WALDORF SCHOOL EARLY CHILDHOODFACILITY NUMBER:
343624040
ADMINISTRATOR:KAT MCFEEFACILITY TYPE:
850
ADDRESS:3750 BANNISTER RDTELEPHONE:
(916) 961-3900
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:15CENSUS: 0DATE:
10/15/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kat Mcfee, Ashley Mack, Michelle Loftus-GoldTIME COMPLETED:
01:30 PM
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Application Specialist (AS) Mai Lor met with Applicant Kat Mcfee, Facility Director Ashley Mack, and Health and Safety/ Kindergarten Teacher Michelle Loftus-Gold for the purpose of an announced pre-licensing inspection. Applicant requested a preschool license to serve 15 preschool children from age three to entry into kindergarten. The facility is located on Sacramento Waldorf School campus and operates in room 16. The program will operate Monday through Friday from 8:00 AM to 12:00pm and from 12:30-5:00pm for extended care. The fire clearance was granted on 10/6/21.

Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, menus, and daily schedule. Prior to this inspection, AS Lor emailed LIC 311A, COVID-19 guides and resources, Effects of Lead Exposure brochure and Provider Notice Information (PIN) 21-21 (Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers per AB 2370). AS Lor reviewed and discussed lead testing requirement and COVID-19 technical assistance with the Applicant. The facility will provide morning snacks and afternoon snacks for children enrolled in the extended care program. Parents will provide lunch for children in the extended care program.

INDOOR ACTIVITY SPACE:
There is one preschool classroom: Classroom #16. AS Lor observed a sufficient number of tables, chairs, cubbies, and napping mats for 15 preschool children. AS Lor observed a variety of age-appropriate toys and equipment. There is a first aid kit in the classroom. Medications will be stored in the in a locked cabinet. Applicant stated cleaning disinfectants will be stored inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated they will utilize a water company to deliver water and have a water dispenser readily available.

Report continues on 809-C.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: SACRAMENTO WALDORF SCHOOL EARLY CHILDHOOD
FACILITY NUMBER: 343624040
VISIT DATE: 10/15/2021
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Applicant stated for outdoor drinking water, children will utilize their own drinking water bottle and use the the outdoor water drinking fountain to refill as needed. AS Lor observed an operable carbon monoxide detector in the classroom. AS Lor observed a paper sign-in/sign-out system.

AS Lor measured the classroom. The total classroom space contains a total of 546.3819 square feet, which accommodates Applicant's request for 15 preschool children. There are seven toilets and six sinks for the children, and a separate private restroom for the staff. Applicant stated the preschool children will share the restrooms with the elementary school children. Facility shall submit a shared restroom waiver request. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the Administration Office area and will use a designated staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property for preschool children. The outdoor play area is fenced with wood fence that is at least four feet tall. AS Lor observed a variety of age-appropriate outdoor toys and equipment. There is no play structure on the premises. There are no bodies of water on the premises. There are shaded areas supplied by trees and overhangs.

AS Lor measured the outdoor activity space. The outdoor play area contains a total of 1029.6236 square feet, which will not accommodate Applicant's request for 15 preschool children. Facility shall submit an insufficient outdoor waiver with a maximum of 13 preschool children outside at any given time. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the preschool file.

This facility plans to provide Incidental Medical Services - IMS. For IMS information, see Evaluator Manuel - Regulation Interpretations and Procedures for Child Care Centers Section 101173 and 101226. A 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.

Report continues on subsequent LIC 809.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: SACRAMENTO WALDORF SCHOOL EARLY CHILDHOOD
FACILITY NUMBER: 343624040
VISIT DATE: 10/15/2021
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Facility Representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

AS Lor discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS Lor discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Facility Representative was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request.



Conditions requiring correction prior to issuing a license:

1. Submit insufficient outdoor waiver request with a maximum of 13 preschool children at a time.
2. Submit shared restroom waiver for the preschool children to share restroom with the elementary school children.
3. Criminal record clearance for Kat Mcfee.
4. Revised Employee Handbook
5. Immunization records (measles) for Kat Mcfee.
6. Licensing Program Manager's final review.

This facility evaluation report was reviewed and discussed with Applicant.

Exit interview conducted and report was reviewed with the Applicant, Kat Mcfee and Facility Director Ashley Mack.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
LIC809 (FAS) - (06/04)
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