493009469-3-6-2025-01-CC-GOUE-DEHQC3-20250306110228

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493009469
Report Date: 03/06/2025
Date Signed: 03/06/2025 11:02:37 AM

Document Has Been Signed on 03/06/2025 11:02 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:	NORTH BAY CHILDRENS CENTER FITCH MOUNTAIN		FACILITY NUMBER:	493009469
ADMINISTRATOR/ DIRECTOR:	SMITH, JOLEYNN		FACILITY TYPE:	850
ADDRESS:	520 MONTE VISTA AVE. RM 6-9		TELEPHONE:	(707) 473-4382
CITY:	HEALDSBRUG	STATE: CA	ZIP CODE:	95448
CAPACITY: 66	TOTAL ENROLLED CHILDREN: 66	CENSUS: 44	DATE:	03/06/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Joleynn Smith		TIME VISIT/ INSPECTION COMPLETED:	11:15 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 unannounced to conduct a case management visit regarding a self reported incident where child C1 was unsupervised in a classroom for a short period of time and for a incident where child C2 was riding a scooter ran into the a fence and sustained a laceration on his forehead. The incident with C1 occurred on 2/26/25. C1 was in the outdoor activity area with all of the students and staff. It appears that C1 entered room 9 at approximately 11:10 for no longer than a few minutes when a teacher left the empty classroom with another child who was using the restroom to relieve another teacher for a lunch break. When the second teacher was entering classroom 9 she saw C1 in the classroom alone. C1 told the staff that it was too noisy and she wanted to go where it was quite. C1 was no injured or in distress. C1 went back to the outdoor activity area to resume playing. The parent and Community Care Licensing were notified of the incident. The facility has developed an extensive plan of correction to prevent a reoccurrence of the incident. The plan includes a face to name check during transitions, Utilizing walkie talkies when a teacher leaves a classroom on duty which includes taking children to and from the bathroom. Lock all classroom doors except for room 8 which is used for toileting. This prevents children from entering other classroom without supervision. Room 8 has the best view to maintain visual supervision if a child does need to be taken to the bathroom. The program has removed any objects in areas that may hinder visual supervision. Staff are also required to routinely scan environment for the supervision of all students which also includes counting the number of children which matches the prior count of students.

Leslie Lepori	TELEPHONE: (707) 588-5060
Glenn Ouye	TELEPHONE: (707) 588-5042
	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

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: NORTH BAY CHILDRENS CENTER FITCH MOUNTAIN	FACILITY NUMBER: 493009469
	VISIT DATE: 03/06/2025

NARRATIVE

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A deficiency is being issued for the lack of supervision, however there was not an immediate health and safety risk to the C1.

On 3/3/25 child C2 was riding a scooter at approximately 9:30am when C2 crashed into the fence with the scooter. C2's forehead hit the handle bar of the scooter which caused a laceration. C2's laceration was treated at a local emergency room. C2 also appeared to have concussion symptoms.
The site supervision indicated that she has currently removed the scooters until she can get enough helmets for the children riding the scooter. The staff will also encourage the children to ride the scooters at a slower rate of speed.

The following deficiency is being cited (see LIC 809D). Appeal Rights were provided via email. A notice of site visit was given via email and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn Ouye	TELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 03/06/2025 11:02 AM - It Cannot Be Edited

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: NORTH BAY CHILDRENS CENTER FITCH MOUNTAIN	FACILITY NUMBER: 493009469
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/06/2025 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision-No child(ren) shall be left without the supervision of a teacher at any time. This requirement is not met as evidenced by: interview with Site Supervisor and unusual incident report facility did not comply with the cited section as child C1	1 2 3 4 5 6 7	The Site Supervision submitted a detailed and implemented plan of correction to prevent a reoccurance of the incident. The deficiency is cleared during the visit.
	8 9 10 11 12 13 14	entered classroom 9 without supervision. Although C1 was unharmed this is a potential health and safety risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Leslie Lepori	TELEPHONE: (707) 588-5060
Glenn Ouye	TELEPHONE: (707) 588-5042
	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

LIC809 (FAS) - (06/04)

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