434405082-6-7-2021-52-CC-JSAR-C3RVMB-20210607163317

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434405082
Report Date: 06/07/2021
Date Signed: 06/07/2021 04:33:29 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: 6	DATE:	06/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:26 PM
MET WITH:	Mayra Wilder		TIME COMPLETED:	04:45 PM

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On 06/07/21 at 2:26 PM, Licensing Program Analyst (LPA) James Sampair, made an Annual Random inspection with Licensee Mayra Wilder. Also present were her assistant, Lilliam Lopez, and husband Jody Wilder.

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 6 children, 4 infants and 2 preschoolers. 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 4A-60-BC 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.

The files of the Licensee, husband, and assistant were reviewed and found to be complete. All 3 had current pediatric 1st Aid and CPR certificates, expiring soon on 07/09/21, so Licensee reminded about renewing every 2 years. Also expiring at the same time is the Mandated Reporter Training, which also expires on 07/09/21, so she was reminded that they all needed to complete the training, which will be easier now that it is in Spanish.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

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: 06/07/2021

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Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov. The Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Individual Medical Services (IMS) policy was discussed. Per licensee, no IMS is being provided at this time. The licensee was reminded that when any changes to the IMS plan is made, an updated Plan for Providing 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.

No deficiency was cited during today’s visit.

An exit interview was conducted with the Licensee. The Licensee was provided a copy of her appeal rights and the signature on this form acknowledges receipt of these rights. A Notice of Site visit was posted at the time of inspection and must remain posted for 30 days and a copy of this report shall be retained at the facility for a minimum of 3 years.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

LIC809 (FAS) - (06/04)

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