434405082-2-21-2020-52-CC-JSAR-BLZU6M-20200221141833

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434405082
Report Date: 02/21/2020
Date Signed: 02/21/2020 02:19:04 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: 3	DATE:	02/21/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Licensee		TIME COMPLETED:	02:30 PM

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I, Licensing Program Analyst (LPA), James Sampair, made an Annual Random inspection of the facility that began at 12:30 pm. The Licensee, Mayra Wilder, was present at the time of the inspection as was her assistant. Her husband live at the home as well, but were not present at the time of the inspection.

The Licensee is utilizing the child care roster and she conducts emergency drills with children under care on a regular basis. The Licensee maintains the capacity on the license. Under care at the time of the inspection were a total of 3 children, 2 infants and 1 preschooler. The Licensee ensured that children are supervised at all times. Each child has safe, comfortable, and healthy accommodations, furnishings, and equipment.

Licensee owns the facility. The on-limits areas are the kitchen, family room, 2 bedrooms, 1 bathroom, and the back yard. The home was kept clean and orderly, with heating and ventilation for safety and comfort, as well as safe toys, play equipment, and materials.

The facility had working smoke detectors, carbon monoxide detectors, and fully charged size 2A10BC fire extinguisher. There were no bodies of water. The Licensee stated that there were no guns or weapons in the home. Licensee has 0 pets.

At 1:45 pm, the licensee and her husband, as well as 1 employee and 3 children's files were reviewed and found to be complete. The all employees had current pediatric CPR and first aid, as well as Mandated Reporter Training certificates.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WILDER, MAYRA	FACILITY NUMBER: 434405082
	VISIT DATE: 02/21/2020

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The licensee meets the criminal background clearance requirement. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint-cleared prior to being in the presence of children or an immediate civil penalty can be assessed.

Also discussed was the importance of referring to and making use of the email list childcareadvocatesprogram@dss.ca.gov to ensure that she is receiving all of the newest licensing updates in a timely fashion. We also went over the list of documents that were to be provided to parents and legal guardians, including the brochure on Lead Poisoning and Safe Sleeping, especially for new parents.

The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (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. Further, when a child enrolls with special medical needs, then an Individual Medical Services (IMS) must be written describing how those medical services will be provided and that a copy of that plan must be submitted to the Department.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

LIC809 (FAS) - (06/04)

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