304313974-3-10-2022-06-CC-KDEI-CCDRZD-20220310122747

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313974
Report Date: 03/10/2022
Date Signed: 03/10/2022 12:28:01 PM

Document Has Been Signed on 03/10/2022 12:28 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	WALDMAN, CINDY		FACILITY NUMBER:	304313974
ADMINISTRATOR:	WALDMAN, CINDY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 505-3559
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	03/10/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Applicant Ms. Waldam, Cindy		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Desai, Ketki conducted an announced in-person Pre-Licensing inspection for a new Large Family Child Care home. LPA met with the applicant Ms. Waldam, Cindy who provided a tour of the new home, along with her family members. It is a Relocation. A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared. Applicant stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Applicant was reminded if changes, to notify the licensing office. The applicant is requesting a Large family childcare home license. Ms. Waldam Cindy has been a Family Child care provider since July 2021 and has been a Early Childhood Educator in a preschool setting and School age setting for several years, qualifying her to be a Large Family Child Provider. Per applicant, operation hours will be Monday to Friday 8:00 AM to 5:00 PM and care and supervision shall be provided to children ages 1 to 5 years only ( Preschool age only) All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story home with 3 bedrooms, 2 living areas, 2 full bathrooms, kitchen, dining area, laundry room, open back yard with 2: side yards and an attached garage. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone is the primary contact phone. Ventilation and heating. The home has a central air and heating system and the unit is installed in the right side yard in the off limit area. There is no stairway in the home. There is one fire place in the home in the living area with a safe metal barrier installed across it and this is in an off limit area. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant states (that there are no poisons on the premises). Applicant was advised that any poisons must be locked with a key or combination lock. (1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/10/2022

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Based on the Facility Sketch submitted, areas off limits to children and parents are: Applicant has designated ( 2 living areas/ 2 bedrooms/ kitchen/ dining room / laundry room/ 1 full bathroom and attached garage as off-limits areas. There is a child safety gate installed at the entrance of the hallway outside the Day care room leading to the kitchen/ dining area/ laundry room and the main living area of the home. Other side of the passage has two bedrooms and one bathroom. Applicant has installed safety latches on top of the doors making them inaccessible, while there is child safety gate installed in front of one bedroom. Garage door on the left side yard, it is locked while the access door is inside the home is through the laundry area, which is off limits to the children. Second living area is adjoining one of the bedroom and there is a safety gate installed making it inaccessible to children. There is door in the day care room, leading into the living area and this door also has a safety latch making the other side inaccessible to children

During the Pre-licensing inspection, LPA observed the designated off limits areas were closed and locked.

The applicant shall use the Cell phone for Day care activities and applicant was informed if a cell phone is used for child care, it must remain on the premises at all times during hours of operation. Applicant was informed and understands the home is to be free from smoking during hours of operation.

Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: Applicant has one bedroom converted into a Day care room with one full bathroom. Left hand side yard and a open back yard with enclosed patio for Day care activities. The children shall enter through the side wooden door on the left side yard , leading to the back yard and enclosed patio area. There are three sliding doors. Only the second sliding door is accessible to children which leads to the Day care room, while the other two sliding doors shall remain closed and locked from inside. The Day care room has several indoor age appropriate toys and educational items for the children. Room is well lighted and ventilated. Children shall nap on sleeping bags and linens and blankets shall be provided by the parents and applicant does have additional linens if needed.

No Infant care is being provided by the applicant.

Upon entrance through the designated side wooden door in the drive way of the home applicant shall receive the children in the enclosed patio area, which has been also set up for Day care activities with wooden table & chairs, benches for children to engage in several indoor / outdoor activities . (2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC809 (FAS) - (06/04)

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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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: WALDMAN, CINDY	FACILITY NUMBER: 304313974
	VISIT DATE: 03/10/2022

NARRATIVE

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Due to pandemic parents are encouraged to follow CDC guidelines, upon entrance temperatures shall be checked, hands shall be sanitized, before children are guided into the designated day care areas.

Applicant has set up a sanitizing station in the patio area on the side table.

Applicant shall provide AM/ PM snacks, lunch shall be offered as an option if agreed by the parents and if food is brought from home and these containers shall be labelled with their names by the parents and stored accordingly.

The bathroom is located on the left side of the passage area, outside the day care room, it has toddler potty chair along with a step stool, there is cabinet under the sink which was observed with paper products. The children's bathroom was observed to be safe and free of hazardous items.

OUTDOOR PLAY AREA: Applicant have designated the backyard for outdoor activities. It is completed fenced with grass flooring . There are several age appropriate outdoor play equipment's arranged under the shaded area. Applicant plans to do gardening activity with the enrolled children and has needed items for it. Enclosed patio area is shaded and has concrete flooring, this area also has several outdoor toys and furniture.

There are no firearms, weapons, or bodies of water in the home.

Applicant has two small turtles as pets, they are placed in off limit area in a cardboard box.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable. Applicant has placed the Fire extinguisher in the kitchen counter as instructed by the Fire Marshal . The home has a new Fire alarm system has been installed and approved by the Fire authorities during the recent inspection.

Applicant have completed the required Mandated Reporter Child Abuse training, Health and Safety training with Nutrition and Lead Poisoning component and Pediatric First Aid and CPR which is valid through 8/27/2022. There are first aid supplies available and was checked on today's inspection for the needed items including First Aid Manual/ tweezers/ anti-septic lotions / bandages and scissors.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC809 (FAS) - (06/04)

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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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: WALDMAN, CINDY	FACILITY NUMBER: 304313974
	VISIT DATE: 03/10/2022

NARRATIVE

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The following was discussed with the applicant:·Applicant Ms. Waldam, Cindy was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification, TB clearance along with a valid criminal record clearance associated to the facility license.
Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Fire and safety drills must be performed every six months and documented for review by the Department.
Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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

Safe Sleep : LPA discussed the safe sleep regulations with Applicant Ms.Waldam, Cindy, discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Applicant Ms. Waldam, Cindy the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC809 (FAS) - (06/04)

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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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: WALDMAN, CINDY	FACILITY NUMBER: 304313974
	VISIT DATE: 03/10/2022

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Subscribe to CCLD important information
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian.

LPA reviewed with applicant Ms. Waldam, Cindy, the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Large Family Child Care Home. LPA explained the age requirements for the enrolled children ensuring that being a Large Family Child Care Home, and with an assistant provider, may provide care for more than 12 and up to 14 children when one child is enrolled in and attending kindergarten (including transitional kindergarten) or elementary school, and another child is at least six years old, and no more than three infants are in care.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment.

Fire clearance approval has been received from Orange County Fire Authority on 2/10/2022 with a specific note : Garage not approved for Day Care.

The facility at the time of Pre-licensing inspection is in compliance for a (Large Family Child Care Home) with Title 22 Regulations. License shall be issued upon Management approval.

Exit interview conducted with the Applicant Ms. Waldam, Cindy this report was read to the applicant.
Appeal rights were presented

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC809 (FAS) - (06/04)

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