434413320-4-19-2022-52-CC-MPRE-CDMUFR-20220419153311

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413320
Report Date: 04/19/2022
Date Signed: 04/19/2022 03:33:25 PM

Document Has Been Signed on 04/19/2022 03:33 PM - It Cannot Be Edited

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, CRISTINA & JESSE		FACILITY NUMBER:	434413320
ADMINISTRATOR:	WILDER, CRISTINA & JESSE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 386-5677
CITY:	MOUNTAIN VIEW	STATE: CA	ZIP CODE:	94041
CAPACITY:	14	CENSUS: 11	DATE:	04/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Cristina Wilder		TIME COMPLETED:	03:30 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	On 4/19/2022 at 1:40pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Cristina Wilder for an Unannounced Annual Inspection. Present during the inspection was the Licensee, one (1) assistant, Jesus “Carmen” Orellana Castellanos, ten (10) preschool age children and one (1) school age child. Licensee’s husband who is the co-licensee was not present. Licensees live in the home with Cristina’s mother. Licensee’s home was toured for a health and safety inspection. The facility operates 7:30am – 5:30pm, Monday - Friday. ON LIMITS AREA: Living Room, Bedroom, Kitchen, Dining Room, Bathroom and Backyard OFF LIMITS AREA: Master Bedroom, Master Bathroom and Converted Garage ISOLATION AREA: Bedroom The facility is a single-story home rented by the Licensee. The inside and outside of the home were observed to be neat, clean with ample age appropriate materials for the children. All toxins, cleaning products, personal medications, and hazardous materials were observed to be in inaccessible areas. The fireplace in the living room is blocked by furniture making it inaccessible to the children in care. Licensee has stated that there are no firearms and no pets in the home. The home has one (1) fully charged 2A10BC fire in the hallway. There is a working smoke detector in the living room and both bedrooms. There is a carbon monoxide detector in the hallway as well. The home is equipped plenty of windows and portable fans and heaters for proper ventilation. LPA did not observe any harmful bodies or water in or around the home. Continued on LIC809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

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, CRISTINA & JESSE	FACILITY NUMBER: 434413320
	VISIT DATE: 04/19/2022

NARRATIVE

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The Licensees Health and Safety training has been completed. Only one Licensee holds a current Pediatric CPR and First Aid training that has been completed and expires 3/7/2024 (see LIC9102TV). Licensees Mandated Reporter training's are current and expires 1/21/2023 and 6/14/2023. Fire/disaster drill log is complete with the last drill logged 1/10/2022. All required forms are posted and visible for public view by the front door of the home. LPA obtained the children’s files, assistants file, and facility roster. All adults have obtained a criminal record clearance and all files were complete.

Licensee was reminded that California Law requires Licensee 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 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process. Continued on LIC809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

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, CRISTINA & JESSE	FACILITY NUMBER: 434413320
	VISIT DATE: 04/19/2022

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Cristina Wilder.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

LIC809 (FAS) - (06/04)

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