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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021686
Report Date: 05/06/2025
Date Signed: 05/06/2025 02:31:29 PM

Document Has Been Signed on 05/06/2025 02:31 PM - 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:PASADENA WALDORF SCHOOLFACILITY NUMBER:
198021686
ADMINISTRATOR/
DIRECTOR:		LAURA M CABRALFACILITY TYPE:
860
ADDRESS:2732 MONTROSE AVETELEPHONE:
(626) 765-9978
CITY:MONTROSESTATE: CAZIP CODE:
91020
CAPACITY: 38TOTAL ENROLLED CHILDREN: 28CENSUS: 20DATE:
05/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Director, Laura CabralTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On May 6, 2025, at 11: 35 am Licensing Program Analysts (LPA) Priscilla Ochoa conducted an unannounced case management inspection for the above facility. LPA was greeted by Director, Laura Cabral, who guided LPA on a tour of the facility. The purpose of this inspection is to follow up on a self-reported incident that occurred at the facility on 05/02/2025. This is a preschool age program which operates Monday through Friday from 9:00 am to 3:00 pm. Per Director, there are 28 children enrolled. LPA observed 20 children in care along with 3 staff members.

Brief summary of incident: During children’s restroom and hand washing break, Child #1 (C1) and Child #2 (C2) hide under a wooden ramp on the play yard while the preschool students and teachers transitioned inside the classroom.

During this inspection, LPA interviewed Staff #1 (S1), Staff #2 (S2), Staff #3 (S3). LPA attempted to interview Child #1 (C1) and Child #2(C2). C1 and C2 refused to speak with LPA. LPA also observed the wooden ramp and playground.

During the course of interviews, S1 disclosed that C1 and C2 had washed their hands and were told to sit on the steps while they wait for the other children to use the restroom and wash their hands. S1 confirms that both children followed instructions and sat down on the steps with the other children. During this time, S1 was assisting another child and did not see C1 and C2 get up and hide under the wooden ramp on the play yard. S1 gathered all children and went inside the classroom. S2 informed LPA that S2 was on break and happened to look out the door and observed 2 children hiding under the wooden ramp. S2 thought C1 and C2 were Kindergarten children as the Kindergarteners were on the play yard at this time. S2 approached C1 and C2 and realized they were Preschool children.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2025
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: PASADENA WALDORF SCHOOL
FACILITY NUMBER: 198021686
VISIT DATE: 05/06/2025
NARRATIVE
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S2 talked to the C1 and C2 about not hiding under the ramp and returned them to their classroom. S1 and S3 realized C1 and C2 were not present until they did a head count inside the classroom. Per S2, S1 and S3 were in the process of starting story time when S2 brought them back to the classroom. Per S2 and S3 the Kindergarten staff did not know that C1 and C2 were hiding under the ramp or on the play yard. Per S1 – S3 the children were left unsupervised for less than 5 minutes on the play yard.

LPA consulted with S1 about making sure children are actively supervised 100% of the time during their time at the facility. Per S1, they are in the process of developing a plan appointing areas where staff need to be focusing on to avoid children hiding in areas where they are not visible, making sure they will have full view of the play yard at all time and also counting the children before leaving the play yard.

Based on inspection of the facility, LPA P. Ochoa informed Director that this report dated May 6, 2025 documents 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Also, LPA P. Ochoa informed the Director to provide a copy of this licensing report dated May 6, 2025, that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. The deficiency listed on the following page was observed by the LPA and is being cited in accordance with California Code of Regulations Title 22 or Health and Safety code. Please see attached LIC 809-D for citation.

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

An exit interview was conducted, and a copy of this report was provided to Director, Laura Cabral.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/06/2025 02:31 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 05/06/2025 at 02:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PASADENA WALDORF SCHOOL
FACILITY NUMBER: 198021686

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/07/2025
Section Cited
CCR
101229(a)(1)

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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation
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Director will finalize written plan for staff members to follow to ensure that children are being supervised at all times. Director will also have staff members watch active supervision video on DSS website.
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C1 and C2 were left unsupervised by staff members on the play yard. Lack of supervision posed an immediate risk to the child in care.
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Director will provide the written plan to LPA and acknowledgment from staff members that they have watched the active supervision video and have reviewed the written plan to LPA by POC date.

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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.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Priscilla Ochoa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2025


LIC809 (FAS) - (06/04)
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