414004757-4-4-2024-05-CC-JGIL-D3ZP4N-20240404105926

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004757
Report Date: 04/04/2024
Date Signed: 04/04/2024 10:59:33 AM

Document Has Been Signed on 04/04/2024 10:59 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	WISE, HAYLEY J.		FACILITY NUMBER:	414004757
ADMINISTRATOR/ DIRECTOR:	HAYLEY J. WISE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 921-0602
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	04/04/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Hayley J. Village		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

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On April 4, 2024, at approximately 8:45 AM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with licensee, Hayley J. Village, and explained the purpose of the inspection. Present during LPA’s visit included licensee and her adult son. Per facility roaster, there are 11 enrolled children (3 infants and 8 preschoolers). No children were present during the visit due to annual Spring Break vacation. The licensee is a large license and is operating within capacity limits and ratio according to facility files and roaster provided.

Licensee lives in the home with adult children. All adults living and/or working in the home have fingerprint clearance on file. Hours of operation are Monday to Friday from 8:00am to 5:30pm.

The home is a single level home that consists of a living room/dining room, sunroom, three bedrooms, two bathrooms, kitchen, laundry room, garage and backyard area. During visit, licensee requested to add bedroom #1 as an additional napping room.

Day Care Areas: the sunroom (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.

Off Limit Areas: the kitchen (pass by only), laundry room, garage, and back portion of backyard.

At approximately 9:20 AM, LPA toured day care areas of home with licensee. LPA observed the home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good working condition. LPA observed a fully stocked accessible first aid kit. LPA did not observe any accessible cleaning supplies, poisons, and solutions in day care areas. LPA observed a fireplace in living room area that was properly barricaded and made inaccessible to children in care. Home is equipped with a fully charged fire extinguisher and multiple carbon monoxide detectors. The licensee also has a fire alarm by the sunroom entrance area. LPA tested carbon monoxide detector in the sunroom, which was observed to be working. LPA observed four sleeping play pens in the nap room with fitted sheets and nothing inside. Playpens were also set up to not block the entry/exit way. Licensee does not have any children in care with allergies or IMS plans. Per licensee, she provides food for all children in care.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WISE, HAYLEY J.	FACILITY NUMBER: 414004757
	VISIT DATE: 04/04/2024

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At approximately 9:40 AM, LPA observed two bathrooms for children's use which were in proper working condition. LPA observed both bathrooms to include appropriate toileting equipment and sanitation products. Per licensee, she always has one assistant staff attend child while they are in the bathroom, and the child is never in there alone. LPA did not observe any hazardous materials to be accessible to children in the bathroom.

The entire backyard is fully enclosed. Stairs in the backyard are properly gated. The outdoor area is equipped with a variety of toys and materials. LPA did not observe pools, spas, or bodies of water.

LPA reviewed five children records which were complete. The children’s files have a record of emergency identification information and required immunization. LPA reviewed staff records for licensee and two assistants which were complete. Licensee's CPR/FIrst Aid is current and will expire 10/2025. The licensee’s Mandated Reporter training certification is also current and will expire 1/2026. The licensee also has required immunization available for review for all staff. LPA also observed both assistants to have current CPR/First Aid that will expire in 10/2025 and 1/2026. Assistants also have Mandated Reporter training certification.

Licensee has licensing documentation properly posted and available for review. The licensee also maintains a childcare roster that was made available for review. Emergency disaster drills are conducted at least once every six months. The last disaster drill was conducted on October 11^th, 2023. Per licensee she also had a earthquake drill on 1/4/2024 and is currently trying to have a disaster drill with the children in her care once a month. Per licensee, there are no weapons or firearms in the home.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WISE, HAYLEY J.	FACILITY NUMBER: 414004757
	VISIT DATE: 04/04/2024

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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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Hayley J Village, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

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

Exit interview conducted and report was reviewed with the licensee, Hayley J. Village.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

LIC809 (FAS) - (06/04)

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