<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423992
Report Date: 11/07/2024
Date Signed: 11/07/2024 11:02:01 AM

Document Has Been Signed on 11/07/2024 11:02 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:WILSON, JULIANA & ZACHARYFACILITY NUMBER:
013423992
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/07/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Juliana & Zachary WilsonTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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 11/07/2024 Licensing Program Analysts (LPAs) J. Vargas and D. Campos met with Juliana and Zachary Wilson for an announced pre-licensing inspection. No other adults or children were present during this inspection. The home was toured with applicants to conduct a Health and Safety Inspection. Per applicant hours of operation will be Monday-Friday 8:00 AM to 5:00PM.

The home is a one story house, which consists of a living room, dining room, kitchen, 3 bedrooms, one and a half bathrooms, a detached garage, 2 locked storage sheds, and fully fenced back yard. The home is neat and clean with heating and ventilation for the safety and comfort of children in care.


The OFF-LIMIT AREAS are all three bedrooms, the back yard, the garage and both storage sheds in the back yard which will be inaccessible by closed and/or locked doors, child proof gates and visual supervision.
The ON LIMIT AREAS are the living room, dining room, kitchen (as walkway to access the half bathroom.
The ISOLATION AREA will be in the dining room. The outdoor play area will be the nearby park (San Pablo park on Park St) until the fully fenced back yard is ready to place on limits for day care children. Applicants were reminded that 100% visual supervision will be required while at the park. There are ample age-appropriate toys that are safe and appear to be clean and in good repair. There are no pools, hot tubs, or any other bodies of water. LPAs did not observe any hazardous materials or toxins accessible to children today.
The home has a fully charged 3 A 40 BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone, and fully stocked First Aid Kit. The applicant’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires 08/19/2025. The applicants have provided proof that the required mandated reporter training was completed on 6/21/2024. The home does not contain a fireplace or wall heater. The home contains central heating and vents are located on the floor. Per applicant, the vents do not become hot to the touch. Per applicant there are no firearms or ammunition in the home. LPAs observed there are 2 cats in the home.

SEE 809-C FOR CONTINUANCE------------------------------------------------------------

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: WILSON, JULIANA & ZACHARY
FACILITY NUMBER: 013423992
VISIT DATE: 11/07/2024
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
26
27
28
29
30
31
32
Page 2.
The applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov

Applicants was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.
LPAs reviewed with applicants the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

On this date, 08/16/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

LPAs discussed the safe sleep regulations with applicants and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPAs also informed applicants 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.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: WILSON, JULIANA & ZACHARY
FACILITY NUMBER: 013423992
VISIT DATE: 11/07/2024
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
26
27
28
29
30
31
32
Page 3.
The applicants rent the home and have provided a copy of the rental agreement as proof of control of property.

The applicants have not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicants understand that, once licensed, they can operate with a maximum capacity of 6 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.

The following pending items must be completed and approved prior to a final licensing determination:

-Visual inspection of the inside of the detached garage and locked shed behind the garage is required as part of the home inspection.

-Final copy of facility sketch (floor plan and yard)

Exit interview conducted and report reviewed with Juliana and Zachary Wilson.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3