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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004757
Report Date: 11/02/2022
Date Signed: 11/02/2022 11:23:15 AM

Document Has Been Signed on 11/02/2022 11:23 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:WISE, HAYLEY J.FACILITY NUMBER:
414004757
ADMINISTRATOR:HAYLEY J. WISEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 921-0602
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 8DATE:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Hayley WiseTIME COMPLETED:
11:30 AM
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On November 2, 2022 at approximately 8:15am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Hayley Wise, and explained the purpose of the inspection. Present during LPA's visit included licensee, two assistants (A1 and A2), and 8 enrolled children (2 infants and 6 preschool age). Licensee is operating within capacity limits and ratio during LPA's visit.

Licensee lives in the home with their adult children. All adults living and/or working in the home have fingerprint clearance on file. Hours of operation are Monday to Friday from 7:30am to 5:30pm.

The home is a single level, family home that consists of an open living room/dining room, sun room, three bedrooms, two bathrooms, kitchen, laundry room, garage and backyard area. During visit, licensee requested to add bedroom #1 as an additional napping room. The DAY CARE AREAS now approved are the sun room (main classroom), bedroom #1 (napping room only), bedroom #2 (activity/nap room), master bedroom (napping room only), bathroom #1 (located in master bedroom), bathroom #2, living/dining area, and lower level and side portion of backyard area. The OFF LIMIT AREAS are the kitchen (pass by only), laundry room, garage and back portion of backyard.

LPA inspected day care areas, inside and outside, for health and safety hazards. The day care areas were observed to be equipped with a variety of toys and equipment that were age appropriate and in good working condition. LPA observed electrical outlets in day care areas to be made inaccessible, blocked by furniture or to have child safety covers. Cleaning supplies, poisons, and other chemicals were also observed to be stored inaccessible in home's high shelves. Living room has a fire place that is properly barricaded and made inaccessible.
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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: WISE, HAYLEY J.
FACILITY NUMBER: 414004757
VISIT DATE: 11/02/2022
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LPA observed entire backyard area to be fully fenced with an at least 5ft. high fence. Children's families enter facility through side gate. Side portion of backyard was observed to be clean and equipped with children's toys and materials that were in good working condition. Flooring in backyard includes grass and resilient padding.

All licensing documents are properly posted and available for review in facility. LPA reviewed eight children's records, whom were present during LPA's visit, which were complete. Children's files have a record of emergency identification information on file. LPA reviewed licensee, A1 and A2's files which were also complete. All staff present have required immunizations available for review and current Mandated Reporter training certificates. Licensee's Pediatric First Aid/CPR is current and will expire 02/2023.

Emergency drills are conducted at least once every six months and are properly logged. Last emergency drill was conducted 10/05/2022. Licensee also maintains sleeping logs for napping infants. Sleeping logs document the 15 minute time check of when infants were last checked on while sleeping. LPA observed cribs to be free of any loose articles and observed infants' files under 12 months to have required napping documentation.

Home is equipped with a working carbon monoxide detector, smoke detector, fire alarm system installed and a working phone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home.

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: 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
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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: WISE, HAYLEY J.
FACILITY NUMBER: 414004757
VISIT DATE: 11/02/2022
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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.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Hayley Wise.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
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