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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006543
Report Date: 04/14/2021
Date Signed: 04/14/2021 03:23:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:NORTH BAY CHILDREN'S CENTER - SCHOOL-AGEFACILITY NUMBER:
493006543
ADMINISTRATOR:KERSTIN BANDNERFACILITY TYPE:
840
ADDRESS:1001 CHERRY STREETTELEPHONE:
(707) 763-6222
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:42CENSUS: 0DATE:
04/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Pam McDonaldTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Glenn Ouye spoke with Site Supervisor Pam McDonald regarding LPA conducting a physical plant inspection. At the time of visit, the site supervisor was cleaning the classroom with one of her staff. The children were not scheduled to arrived until 1:30pm due to hybrid school programming.

LPA was on site to do a capacity determination on a day and time when the children were not present. Two building were inspection. The exterior outdoor play area was also inspected. LPA Ouye and Champions representative conducted a capacity determination at the location which is on the Mary Collins School at Cherry Valley in Petaluma, Ca.

Site supervisor Pam also indicated to LPA Ouye that the program will be closing in the future and that is why the new company is asking for the capacity determination.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021
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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