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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615250
Report Date: 11/16/2023
Date Signed: 11/16/2023 10:32:50 AM

Document Has Been Signed on 11/16/2023 10:32 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DAVIS WALDORF SCHOOLFACILITY NUMBER:
573615250
ADMINISTRATOR:JENNIFER SLATERFACILITY TYPE:
850
ADDRESS:3100 SYCAMORE LANETELEPHONE:
(530) 753-1651
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 72DATE:
11/16/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jennifer SlaterTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Jennie Tedlos (JT) and Centralized Application Bureau (CAB) Alecia Sifuentes (AS) met with Director, Jennifer Slater for the purpose of a room addition case management inspection. Licensee is not requesting any changes to the capacity. Licensee requests to add the Buttercup Room as a fifth preschool room at the facility. The program operates Monday through Friday from 8:00 a.m. to 5:30 p.m. The fire clearance was granted and received on 10/27/2023.

INDOOR ACTIVITY SPACE:
In the Buttercup Room, JT and AS observed a sufficient amount of equipment, toys, tables, chairs, nap mats, and cubbies. There are 2 toilets, 3 sinks, and an additional sink in the kitchenette area. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). AS measured the classroom and included the square footage to the total indoor square footage. The total indoor square footage for all 5 classrooms, Buttercup, Morning Glory, Climbing Rose, Lavender room, and Golden Poppy, contains a total of 3,648 square feet, which will accommodate Licensee's current capacity of 90 preschool children.

Licensee 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director, Jennifer Slater.

Effective today, 11/16/2023, LPA will approve the room addition.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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