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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008944
Report Date: 03/23/2022
Date Signed: 03/24/2022 08:17:04 AM

Document Has Been Signed on 03/24/2022 08:17 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BRIGHT SKIES MONTESSORIFACILITY NUMBER:
493008944
ADMINISTRATOR:AISHWARYA KANCHARLAFACILITY TYPE:
850
ADDRESS:11201 MAIN STREETTELEPHONE:
(707) 665-9830
CITY:PENNGROVESTATE: CAZIP CODE:
94951
CAPACITY: 36TOTAL ENROLLED CHILDREN: 25CENSUS: 6DATE:
03/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Caroline Wagner, Center DirectorTIME COMPLETED:
05:01 PM
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
An unannounced case management visit was made by Licensing Program Analyst (LPA) Yang in response to a self-reported Unusual Incident Report (UIR) that was submitted by the facility on 03/16/22. During today's case management visit, the LPA met with the facility's director Caroline Wagner to discuss the incident. It was reported that on 03/14/22 at approximately 01:30pm, child C1 stepped on a plant vine and wood trellis located in the corner of the play yard and used it to climb over the four feet tall, chain link fence and on to the adjacent property. The director reported that the child, along with seven other children were visually supervised by teacher S2 at the time of the incident. The director reported that S2 observed that C1 had climbed over the fence and went to retrieve the child. The director reported that the child was uninjured and not in distress.

During today's case management visit, the LPA toured the outdoor play area and made observations and recommendations. Staff S2 was present at the facility and was interviewed as well. As a result of this incident, the center director stated that the plant vine and trellis was moved approximately two feet away from the fence and an additional four foot tall, natural wood snow fence with vertical slats was installed in that area to create a buffer between the main chain link fence and the vine plant and trellis. The center director stated that additional supervision will be provided to this area. This facility currently has a waiver on file due to some parts of the playground fence being lower than the required height of four feet.

This incident was reported to Community Care Licensing and the child's parent/guardian as required. During today's visit, staff were observed to be providing appropriate care and supervision. This report was read and reviewed with the center director, Caroline Wagner. There were no Title 22 deficiencies cited during today's inspection.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2022
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 1