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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213000763
Report Date: 10/21/2025
Date Signed: 10/21/2025 06:20:36 PM

Document Has Been Signed on 10/21/2025 06:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:NORTH BAY CHILDREN'S CENTER-INFANTFACILITY NUMBER:
213000763
ADMINISTRATOR/
DIRECTOR:		KRISTINA SISSECKFACILITY TYPE:
830
ADDRESS:932 C STREETTELEPHONE:
(415) 883-6222
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 31DATE:
10/21/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Kristina Sisseck & Paige NewtonTIME VISIT/
INSPECTION COMPLETED:
06:30 PM
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On October 21, 2025 at approximately 9:40AM, Licensing Program Analysts (LPAs) Nicole Tran and Jonathan Tse conducted an unannounced, annual inspection. LPAs met with Chief Program Officer, Kristina Sisseck, and explained the purpose of the visit. Program Director, Paige Newton, also joined the visit. Present during the visit was 18 staff, 16 infants, and 15 toddlers.

The facility is an infant program with a toddler component. The infant program operates in four classrooms: 170, 175, 177, and 181. There is a preschool program onsite that operates in classrooms 102, 107, 112, and 116. Room 127 is also used as an art therapy room.

With Program Director, LPAs inspected classrooms 170, 175, 177, 181, and 127 for health and safety hazards. LPAs observed electrical outlets in classrooms to be made inaccessible with child safety covers. Facility is equipped with multiple fire extinguishers, first aid kits, carbon monoxide detectors, and a fire alarm system. LPAs tested and verified the functionality of the carbon monoxide detectors. Chemicals, poisons, and cleaning solutions have been made inaccessible to children.

LPAs observed a variety of age-appropriate toys that are in good condition. Classrooms have rugs and soft cushioning for infants to play and rest on. Age-appropriate furniture was observed to be maintained in good condition, free of sharp, loose or pointed parts. LPA observed cabinets and drawers in classrooms to be free of poisonous materials. Storage for children's belongings are located inside the classroom and are labeled with their names. There are multiple garbage bins with tight fitting lids in the children's restrooms and classrooms.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NORTH BAY CHILDREN'S CENTER-INFANT
FACILITY NUMBER: 213000763
VISIT DATE: 10/21/2025
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Children sleep in cribs and on cots depending on their needs. Sheets are provided by the facility while blankets are provided by families. Per Program Director, the facility launders sheets weekly and families bring home the blankets to wash. LPAs observed children’s bedding to be individually stored so that no child’s used bedding comes into contact with other bedding. LPAs reviewed sleep logs and found them to be complete with staff’s initials and timestamps.

Restrooms for children's use were observed to be in working condition. LPAs observed children's restroom to have age-appropriate toileting equipment and hand washing materials. Changing tables were in the bathroom within arm’s reach of a sink. Per Director, parents provide diapers and LPAs observed them to be stored in baskets, labeled with children’s names and photos. The facility also has extra diapers if needed.

The facility provides a food service that includes breakfast, lunch, and afternoon snack. Food menus are posted by the front entrance and in classrooms. The facility provides water bottles for children and has a different design for each classroom. LPAs observed children’s water bottles and milk bottles to be labeled with their names. Water bottles are refilled through the classroom’s refrigerator water dispenser or by Brita water pitchers.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

This facility was constructed after 2010 and therefore is not required to test its fixtures for lead.

With Program Director, LPAs inspected the outdoor area for health and safety hazards. The outdoor area is called the Infant Play Area and is shared between the infant and toddler classrooms. The facility has an outdoor rotation waiver to prevent infants and toddlers from comingling. LPAs observed the facility to be in compliance with the waiver during today’s visit.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NORTH BAY CHILDREN'S CENTER-INFANT
FACILITY NUMBER: 213000763
VISIT DATE: 10/21/2025
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The Infant Play Area is fully enclosed and fenced. Play structures have woodchips and grass underneath to cushion falls. Trees, tarps, and structures provide shade for children to rest under as well. Per Program Director, the sandbox is checked every morning. There is also a cover to pull over the sandbox when not in use to prevent debris from falling in. Age-appropriate toys and equipment were observed to be in good condition. Changing tables are available within arm’s reach of a sink as well. LPAs did not observe any pools, spas or bodies of water on site.

Licensing documents are properly posted and available for review by the front entrance and in classrooms. The facility utilizes paper sign in/sign out sheets. LPAs observed children present to be appropriately signed in during today's visit.

LPAs reviewed 6 random children's records. Children's files were observed to be complete and included emergency information and consent for emergency medical authorization. LPAs reviewed 11 staff files. There is at least one staff member onsite with current pediatric CPR/First Aid training. Six out of eleven staff files do not have current Mandated Reporter training available for review.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NORTH BAY CHILDREN'S CENTER-INFANT
FACILITY NUMBER: 213000763
VISIT DATE: 10/21/2025
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records.

For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

See LIC 809-D for deficiency cited today regarding Mandated Reporter training.

A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided and explained.

Exit interview conducted and report was reviewed with facility representative, Kristina Sisseck.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/21/2025 06:20 PM - It Cannot Be Edited


Created By: Nicole Tran On 10/21/2025 at 05:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: NORTH BAY CHILDREN'S CENTER-INFANT
FACILITY NUMBER: 213000763

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 6 out of 11 staff files, current Mandated Reporter training was not available for review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/14/2025
Plan of Correction
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The facility shall email LPA Tran evidence of all staff completing current Mandated Reporter training. Mandated Reporter training can be completed at https://mandatedreporterca.com/
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Nicole Tran
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2025


LIC809 (FAS) - (06/04)
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