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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700491
Report Date: 08/23/2023
Date Signed: 08/23/2023 10:53:37 AM

Document Has Been Signed on 08/23/2023 10:53 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WISEMAN, COURTNEYFACILITY NUMBER:
015700491
ADMINISTRATOR:WISEMAN, COURTNEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 942-7624
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/23/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:applicant, Courtney WisemanTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Jyoti Saini met Applicant Courtney Wiseman for a scheduled prelicensing visit today. The purpose of this inspection was explained. This is a change of location from a previously licensed family childcare home. The facility was previously licensed at 4750 TASSAJARA RD, #5116 Dublin, CA 94568. Applicant stated that she is the only one who lives in this house. Applicant is applying for a large family childcare license with hours of operation: Monday through Friday 8:30 A.M. to 5:30 P.M. Capacity requirements were discussed today. Criminal record clearances are on file and will be transferred to this location. The facility has approved fire clearance. The entire house was inspected for health and safety hazards.
Day care areas: the entire downstairs area consisting of Living room (main play area), bedroom #1 on the right-hand side to the entrance that will be used as play area/nap area, kitchen, dining area, closet underneath the stairs (to store cots only), Dining room, kitchen, and backyard.
Off-limit areas: the entire second level, all stairways, bathroom #2, bedroom #2, bedroom#3, master bedroom and adjacent bathroom, laundry room, and garage.
Applicant understands that all off limits areas of the home shall be kept inaccessible to children via barricade, locked doors, and/or visual supervision. The home has smoke detectors, a working cell phone, and first aid/emergency kit supplies. Per applicant, there are no firearms or weapons in the home. All sharp objects, cleaning supplies and other toxic items are stored out of reach of the children. There are no pools, ponds, hot tubs, or any other bodies of water on the facility premises at this time. Applicant has required Preventive Health and Safety Training certificate, including lead poisoning prevention update. The Facility will be providing snacks and meal. Applicant's First Aid/CPR certificate expires in 5/21/2025. Mandated Reporter training certificates for Applicant are current and expire on 03/03/2024. Applicant is reminded of NO walker, exersaucers, jumpers, bouncers, and any similar items to be used for children in care and shall be made inaccessible. Smoking is prohibited in family childcare homes. The Applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.
see next page...
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WISEMAN, COURTNEY
FACILITY NUMBER: 015700491
VISIT DATE: 08/23/2023
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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-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.

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.

Applicants were informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.



Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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



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/inspection-process.

Large Family Child Care License is recommended effective today ( 8/23/2023)

Exit interview conducted and report was reviewed with the applicant, Courtney Wiseman,
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC809 (FAS) - (06/04)
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