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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434405082
Report Date: 07/16/2019
Date Signed: 07/16/2019 03:48:05 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, MAYRAFACILITY NUMBER:
434405082
ADMINISTRATOR:WILDER, MAYRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 967-8352
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY:14CENSUS: 2DATE:
07/16/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Mayra WilderTIME COMPLETED:
04:00 PM
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LPA Janet Tse met with licensee Mayra Wilder for a Plan of Corrections inspection. LPA explained the nature of today's inspection to Licensee. LPA observed two infants with Licensee and her assistant in the home. Present was also Licensee's husband.

LPA observed Licensee has completed the Mandated Reporter AB1207 Compliant Child Care Training on 07/09/2019. Certification is in file. Licensee understands the training is to be taken every two years. EMSA approved Adult and Pediatric First Aid/CPR certification is current expiring on 07/09/2021. Licensee stated that the documents were faxed to Licensing after office hours yesterday. Type B Deficiency cited on 06/18/2019 was cleared and a copy of the cleared plan of corrections letter was provided to Licensee today.

No deficiency was cited. Notice of site visit was issued and must be posted for 30 days.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
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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