434405082-6-18-2019-52-CC-JTSE-BD9V6Y-20190618161020

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434405082
Report Date: 06/18/2019
Date Signed: 06/18/2019 04:10:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	WILDER, MAYRA		FACILITY NUMBER:	434405082
ADMINISTRATOR:	WILDER, MAYRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 967-8352
CITY:	MOUNTAIN VIEW	STATE: CA	ZIP CODE:	94040
CAPACITY:	14	CENSUS: 0	DATE:	06/18/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Mayra Wildser		TIME COMPLETED:	04:20 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	LPA Janet Tse met with licensee Mayra Wilder for an annual/required inspection. LPA explained the nature of today's inspection to Licensee. The house was under interior painting today. LPA observed no day care children. Licensee stated that the painting started yesterday and will be finished today. Child care will resume tomorrow 06/19/2019. Licensing was not advised of the painting and the days for closure. Present were also Licensee's husband and three construction workers. Days and hours of operation are Monday to Friday, 7:30am to 5:30pm. The adults that reside in the home are licensee and her husband. LPA toured the indoor and outdoor of the home. LPA observed a screened fireplace and no wall heaters. LPA observed no stairs. Off limits indoor: master bedroom, master bathroom, kitchen, garage, and the laundry area. There are no bodies of water. Licensee stated there is no firearms/weapons in the home. Backyard is fenced. The entire backyard including the side yard is used for the day care children. LPA reminded licensee that she can only have 14 children according to her license. Fire extinguisher is size 3A40BC and filled. Smoke and carbon monoxide detectors are operable. Home is with heating and ventilation for safety and comfort. LPA observed sufficient materials, toys, and play equipment for the day care children. Telephone is in working order. LPA went over substitute options. LPA also discussed if Licensee transports children, they are never to be left in parked vehicles. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 06/17/2019 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. A copy of the current roster of the children was provided to LPA today. LPA reviewed four children's files. LPA observed that in each child’s record has a copy of the emergency information card that contains all of Facility Evaluation Report dated 06/18/2019 to be continued on next page:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WILDER, MAYRA	FACILITY NUMBER: 434405082
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/18/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/16/2019 Section Cited CCR 102416(c)	1 2 3 4 5 6 7	The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee shall renew her Pediatric CPR/1st Aid certification and forward a copy, both front and back, to LPA by 07/16/2019 due date.
	8 9 10 11 12 13 14	LPA observed Licensee's Pediatric CPR/1st Aid expired on 05/10/2019. This poses a potential risk to the Health, Safety, or Personal Rights of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WILDER, MAYRA	FACILITY NUMBER: 434405082
	VISIT DATE: 06/18/2019

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Facility Evaluation Report dated 06/18/2019 to be continued from previous page:

the information specified by regulation. LPA observed Licensee's Pediatric CPR/1^st Aid expired on 05/10/2019.

Licensee was given a list of the current forms for childcare. LPA discussed the immediate civil penalties for Zero Tolerance of $500, and an ongoing $100 per day per violation continues until the violation(s) is corrected. LPA also discussed the Healthy Beverage Act and AB633 requirements for type A violation. SB 792 Immunization Requirements was discussed. LPA observed the required immunization records for Licensee and her assistant (LL) are in file. LPA observed Licensee has completed the Mandated Reporter Training on 02/26/2018, and a copy of the certification was in file. However, the training Licensee took was for educators, Mandated Reporter School Personnel Training. LPA advised Licensee to retake the training online for child care providers. Website to complete the Mandated Reporter AB1207 Compliant Child Care Training: www.mandatedreporterca.com. Licensee speaks and understands English even though her mother language is Spanish. This inspection was conducted primarily in English.

Licensee is not providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care. Information on safe sleep and lead poisoning was provided to Licensee. Licensee was advised to inform parents regarding these topics.

Deficiency was cited. Notice of site visit was issued and must be posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019

LIC809 (FAS) - (06/04)

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