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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 213005592
Report Date: 11/12/2024
Date Signed: 11/12/2024 03:32:13 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2024 and conducted by Evaluator Nathan Garcia
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20241015130950
FACILITY NAME:NORTH BAY CHILDREN'S CENTER-TINKER WAY CAMPUS-S/AFACILITY NUMBER:
213005592
ADMINISTRATOR:SISSECK, KRISTINAFACILITY TYPE:
840
ADDRESS:22 TINKER WAYTELEPHONE:
(415) 883-6222
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:56CENSUS: 9DATE:
11/12/2024
UNANNOUNCEDTIME BEGAN:
02:43 PM
MET WITH:Donje Fields/Brent KnipeTIME COMPLETED:
03:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide appropriate supervision to child in care
Staff released day care child to an unauthorized individual
Staff did not ensure individual who removed day care child from the facility followed sign out procedures
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On November 12, 2024, Licensing Program Analyst (LPA), Nathan Garcia conducted an unannounced conclusionary complaint inspection and met with area director, Donje Fields and site director, Brent Knipe to discuss the above allegations. Purpose of the inspection was explained. Present in the facility were 4 staff members supervising 6 children.

During the course of the investigation, interviews were conducted, and pertinent documentation were reviewed. LPA has determined that the allegation of "Staff did not provide appropriate supervision to child in care", "Staff released day care child to an unauthorized individual", "Staff did not ensure individual who removed day care child from the facility followed sign out procedures." is SUBSTANTIATED, meaning the preponderance of evidence standard has been met. LIC 9099D is on the next page for the deficiency.

LPA conducted exit interview with area director, Donje Fields.

Report and Notice of Site Visit was provided.
Notice of Site Visit shall be posted for 30 consecutive days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 05-CC-20241015130950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NORTH BAY CHILDREN'S CENTER-TINKER WAY CAMPUS-S/A
FACILITY NUMBER: 213005592
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/13/2024
Section Cited
CCR
101229(a)(1)
1
2
3
4
5
6
7
101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
1
2
3
4
5
6
7
The facility will develop a plan make sure that the children are always supervised during pick up times.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Based on interviews, and record review, the licensee did not comply with the section cited above, which poses an immediate health, safety, or personal rights risk to children in care.
8
9
10
11
12
13
14
Proof of attendance of the trainings administered regarding care and supervision will be forwarded to LPA by set due date.
Type B
12/13/2024
Section Cited
CCR
101229
1
2
3
4
5
6
7
101229.1 Sign In and Sign Out
1
2
3
4
5
6
7
The facility will develop sign in/out procedures where the teachers will ensure the correct authorized representatives picking up the child.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Based on interviews, and record review, the licensee did not comply with the section cited above, which poses a potential health, safety, or personal rights risk to children in care.
8
9
10
11
12
13
14
The facility will implement the new protocols for sign in/out of children by set due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2