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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009469
Report Date: 12/03/2019
Date Signed: 12/06/2019 08:13:04 AM

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 CHILDRENS CENTER FITCH MOUNTAINFACILITY NUMBER:
493009469
ADMINISTRATOR:PORTER,NICOLEFACILITY TYPE:
850
ADDRESS:520 MONTE VISTA AVEUNE, RM 8&9TELEPHONE:
(707) 473-4382
CITY:HEALDSBURGSTATE: CAZIP CODE:
95448
CAPACITY:54CENSUS: 35DATE:
12/03/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Nicole PorterTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Y. Yang conducted an unannounced case management visit in follow up to the recent Public Safety Power Shutoffs (PSPS) and fire evacuations. The site supervisor confirmed there were no significant impacts affecting the facility's operational capabilities, however, power and gas were shut off for a period of time. The site supervisor stated that the facility closed for a week and a half.

The facility is observed to be in full operation today with no identified health and safety issues or unmet needs. LPA also verified the most current contact information and obtained additional contact information from the site supervisor. No deficiencies cited for areas observed today. Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019
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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