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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313974
Report Date: 03/01/2022
Date Signed: 03/01/2022 11:25:44 AM

Document Has Been Signed on 03/01/2022 11:25 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:WALDMAN, CINDYFACILITY NUMBER:
304313974
ADMINISTRATOR:WALDMAN, CINDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 505-3559
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Applicant Ms. Waldam, Cindy TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Desai, Ketki conducted an announced Pre-Licensing inspection at the new Large Family Child Care home.
LPA met with the Applicant Ms. Waldam, Cindy at the home. It is a Relocation.

However at the time of the inspection today, the home is not ready with the Day care set up, needs the indoor and outdoor set up for an inspection.

Applicant needs an additional one week time to complete the requirements per Title 22 to be in compliance for a Large Family Child Care Home.

LPA shall conduct a follow up inspection on 10th of March.

Exit interview held with Ms. Waldam, Cindy.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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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