493010418-6-29-2023-01-CC-GOUE-CT9P48-20230629105843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493010418
Report Date: 06/29/2023
Date Signed: 06/29/2023 10:58:48 AM

Document Has Been Signed on 06/29/2023 10:58 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 MONTESSORI-INF		FACILITY NUMBER:	493010418
ADMINISTRATOR:	CAROLINE WAGNER		FACILITY TYPE:	830
ADDRESS:	11201 MAIN STREET #159		TELEPHONE:	(707) 665-9830
CITY:	PENNGROVE	STATE: CA	ZIP CODE:	94951
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 5	CENSUS:	DATE:	06/29/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Aishwarya Kancharla		TIME COMPLETED:	11:00 AM

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	Licensing Program Analyst (LPA) Glenn Ouye arrived to conduct a prelicensing inspection. The licensee has had an existing preschool program at this site and will now be adding an infant program to the site as well. The application for 8 infants was received on April 18, 2023. The fire clearance was approved for 5 infants. The program will offer the infant program for children who are between one years old and two years old. The application was received by the department on April 18, 2023. There is sufficient square footage to support up to eight infants at this age group, however at this time the fire clearance is approved for 5 infants. There is a single great room that will be utilized for the program. There are age appropriate furniture, equipment and toys available for the children. Children in the program will have already graduated out of cribs and mats will be used for napping children There is a functional smoke and carbon monoxide detector and a fire extinguisher rated at lease 2A10BC. There is one toilet and two sinks in the classroom. The facility will also utilize a diaper changing mat within arms reach of the sink. There is a refrigerator to store formula and breast milk for the children attending the program. The outdoor activity area supports up to 11 children and has age appropriate equipment and toys to the children. The program will utilize BrightWheel for sign in and sign out. The Licensee was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 Child Care Center. 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.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: BRIGHT SKIES MONTESSORI-INF	FACILITY NUMBER: 493010418
	VISIT DATE: 06/29/2023

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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.

LPA reviewed with [applicant, licensee, or facility representative] the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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 [applicant, licensee, or facility representative] 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.

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.

The facility is approved for licensure for 5 infants effective today, June 29, 2023.

Exit interview conducted and report was reviewed with Licensee, Aishwarya Kancharla.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

LIC809 (FAS) - (06/04)

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