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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009256
Report Date: 01/27/2022
Date Signed: 01/27/2022 03:49:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MARY BIRD EARLY CHILDHOOD EDUCATION CENTERFACILITY NUMBER:
483009256
ADMINISTRATOR:ANNA MANSKARFACILITY TYPE:
850
ADDRESS:420 EAST TABOR AVENUETELEPHONE:
(707) 438-3684
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:216CENSUS: 39DATE:
01/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Center Director Anna ManskerTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres, conducted an unannounced case management visit to receive additional documentation from an unusual incident report the regional office received on 12/15/2021. It was alleged a child was hit on the right knee on 12/09/2021.

LPA received contact information for the parties involved, interviewed Center Director, and two additional staff on 01/27/2022. The child involved in the incident no longer attends the facility. Fairfield Police conducted an investigation into the incident on 12/09 and 12/10 and found the incident to be unsubstantiated. Center director and program director investigated the alleged incident as well and found the incident to be unsubstantiated. Staff present at the time of the alleged occurrence corroborated the child was not left alone with any staff member. Interviews further revealed the only time a staff member was near the child was to help them get dressed, the staff member was never left alone with the child.

There were no Title 22 deficiencies cited today. Notice of site visit shall be posted for 30 days.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez TorresTELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
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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