414004757-12-30-2020-05-CC-WLYY-BWSS7M-20201230123747

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004757
Report Date: 12/30/2020
Date Signed: 12/30/2020 12:38:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	WISE, HAYLEY J.		FACILITY NUMBER:	414004757
ADMINISTRATOR:	HAYLEY J. WISE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 921-0602
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 0	DATE:	12/30/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Hayley Wise		TIME COMPLETED:	12:00 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	Due to COVID-19 and DPH guidelines of social distancing, Licensing Program Analyst (LPA) Winnie Ly conducted the Relocation Pre-Licensing tele-inspection via FaceTime on December 30, 2020 at 9:30am with Licensee Hayley Wise. Present at the home during the tele-inspection was Licensee. Licensee rents this home and resides on premises. The home consists of open livingroom/dining room, a large room, three bedrooms, two bathrooms, kitchen, laundry room, garage and a backyard. The Day care areas are the large room as a classroom, bedroom #2 for children's group activities, licensee's master bedroom for infant to nap, bathroom in master bedroom, a bathroom next to bedroom #2, dining area for children to do art activities, the back yard and the side yard for children's outdoor activities. Per licensee, children and parents will enter daycare by the side gate which lead them into the side yard. The off limit areas are Bedroom #1 and the kitchen. All off limit areas have doors or gates to prevent children from entering. Home has Fire Clearance Approval from the City of San Mateo. During the tele-inspection, the home is clean, safe, and has working smoke detector, carbon monoxide detector, fire extinguisher, and telephone. Licensee has a first aid kit and a thermometer. There are no bodies of water on the premises. Home has age appropriate toys and equipment available for the children in care. Licensee is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care. Those items shall be made inaccessible to children. Discipline policy was discussed with applicant. Per Licensee, home does not have firearms or dangerous weapons. CONTINUED>>>

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2020

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WISE, HAYLEY J.	FACILITY NUMBER: 414004757
	VISIT DATE: 12/30/2020

NARRATIVE

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Licensee is also been advised all adults, 18 years and older living in the home, helper, or assistant must have criminal background clearance and must be associated to the facility by submitting an LIC 9182 with copy Ca. ID prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.

Incidental Medical Services (IMS) to children at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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

Licensee was also informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPA discussed Child Abuse Mandated Training AB1207 with Applicant. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Licensee was also advised to reach out to San Bruno Regional Office for concern or questions. Desk Duty is available M-F, 8a.m.-5p.m. (650) 266-8800. Website for forms and regulations updates: www.cdss.cs.gov/inforesources/Community-Care-Licensing

A copy of this report will be emailed to applicant. Licensee was advised to acknowledge receipt of report once received.

Prior to Licensure: Licensee needs to email acknowledgement of receipt of Pre-Licensing report to LPA.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2020

LIC809 (FAS) - (06/04)

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