214005525-9-1-2020-05-CC-HRCO-BT2PSG-20200901113416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005525
Report Date: 08/25/2020
Date Signed: 09/01/2020 11:35:08 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	NORTH BAY CHILDREN'S CENTER-HAMILTON		FACILITY NUMBER:	214005525
ADMINISTRATOR:	KRISTINA SISSECK		FACILITY TYPE:	850
ADDRESS:	5530 NAVE DRIVE		TELEPHONE:	(415) 883-6222
CITY:	NOVATO	STATE: CA	ZIP CODE:	94949
CAPACITY:	22	CENSUS: 0	DATE:	08/25/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Kristina Sisseck & Teri Porter		TIME COMPLETED:	12:00 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	Licensing Program Analysts (LPAs) Haydee Caliboso and Adam Rodriguez met with Kristina Sisseck (VP of Programs), Teri Porter (Area Director), and Stephanie Kuyper on 8/25/20 for a pre-licensing inspection. The applicant has requested a capacity of 23 children, ages 2 years to entry into kindergarten. Due to COVID-19, facility is only requesting to have 12 children. The facility is located in Hamilton School in Novato and will operate Monday - Friday; 7:30AM to 5:30 PM. The designated site supervisor for the facility is Stephanie Kuyper. The facility was inspected today, indoor and outdoor, for health and safety hazards, and measured to calculate capacity. Indoor: The classroom measures 836.5 square feet allowing for a capacity of 23 children. The classroom and furniture are clean. Children’s toys and supplies are orderly, in good condition, and age-appropriate. There is storage space for children's personal belongings and cots to be utilized for napping children. Parents will provide a sheet and blanket for their child. Bedding is sent home to be washed weekly or when needed. Cots will be cleaned at least weekly or more often if needed. The classroom is equipped with a fire extinguisher, smoke, and carbon monoxide detectors. The classroom has a kitchen area with a working refrigerator where snack food is stored. The garbage cans have tight-fitting lids. The classroom has a designated back for first aid kit and emergency supplies. Refrigerated medications will be stored separately from food. Medication will be administered with parental consent and will be kept in child’s file for record. All medication will be logged when administered to children. The program will provide breakfast, lunch, and snacks daily. Only disposable products will be used for food service. Cont. 809-C

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NORTH BAY CHILDREN'S CENTER-HAMILTON	FACILITY NUMBER: 214005525
	VISIT DATE: 08/25/2020

NARRATIVE

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There is 1 toilet and 1 sink accessible for children's use inside the bathroom. The bathrooms are clean and with no health or safety hazards. There is another sink available for children to use inside the classroom located by the entrance door. The capacity for 1 toilet is 15 and 2 sinks is 30. The facility has another bathroom outside the classroom across the hall. A sign is posted on the door that bathrooms are to be used for children during the hours of care. All cleaning supplies and hazardous items are stored in a locked cabinet made inaccessible to children. Isolation of ill children will be located in a corner space of the classroom, and a staff bathroom will be used for the ill child. There are designated bathrooms for staff to use. Pitchers of water and disposable cups will be provided for indoor and outdoor use.

Outdoor: The outdoor area measures 2275 square feet, allowing for a capacity of 30 children. The outdoor area is enclosed by at least a four-foot fence and observed to be clean, safe, and equipped with toys for children. Sandbox is clean and will be inspected daily and kept free of hazardous materials. Climbing structure is in good condition and wood chips are used under the climbing structure. There is abundant natural shade and wood chips are also used on the play yard. The facility will conduct monthly disaster drills and a log will be maintained for review upon request

The following items were reviewed as part of today's visit: Record keeping for staff, children and facility records, Care and Supervision of the Children, Child Discipline Procedures- staff will talk with the children and use redirection, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Transportation-none provided, Parents Rights, and Reporting Requirements.

This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.
Cont. 809-C

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NORTH BAY CHILDREN'S CENTER-HAMILTON	FACILITY NUMBER: 214005525
	VISIT DATE: 08/25/2020

NARRATIVE

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The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (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

An electronic copy of this three-page report was emailed to applicant Kristina Sisseck and Teri Porter. Applicant was asked to review the report and return a signed copy of the report to LPA Haydee Caliboso.

Based on availability square footage, sinks, and toilets LPA Haydee Caliboso will recommend licensure of this facility for a maximum capacity of 23 children. The following is required prior to licensure:

· Updated LIC200A
· Board of Resolution authorizing Kristina Sisseck to act in behalf of the corporation
· Kristina Sisseck current LIC 503 Health and Screening Report and current TB clearance
· Kristina Sisseck Mandated Report, Orientation for Application and Record Keeping
· Kristina Sisseck current First Aid CPR and Preventative Health and Safety
· Provide and indicate additional Temporary Relocation site and Utility Shut-Off Location on LIC200A form.
· Fire Clearance approved by Novato Fire Department

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020

LIC809 (FAS) - (06/04)

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