214005456-2-26-2026-05-CC-NTRN-DL7W56-20250904165836

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005456
Report Date: 09/04/2025
Date Signed: 02/26/2026 04:30:15 PM

Document Has Been Signed on 02/26/2026 04:30 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 MARIN COMMUNITY SERVICES (SA)		FACILITY NUMBER:	214005456
ADMINISTRATOR/ DIRECTOR:	CHERYL PADDACK		FACILITY TYPE:	840
ADDRESS:	680 WILSON AVE		TELEPHONE:	(415) 892-1643
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY: 168	TOTAL ENROLLED CHILDREN: 80	CENSUS: 70	DATE:	09/04/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Program Director, Emily Bugos		TIME VISIT/ INSPECTION COMPLETED:	05:20 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	On 9/4/2025, at approximately 1:00PM, Licensing Program Analysts (LPAs) Tran and Van conducted an unannounced annual inspection at the facility. LPAs met with Program Director, Emily Bugos (D1), and explained the purpose of the visit. There were 8 staff and 70 school age children present at the facility. The facility is located on-site with their preschool program as well. The school age program’s license allows school-aged children to be served in the following rooms: Annex, Art Room, Games Room, Dining Room (now called Friends Room), Friends Room (now called TK/Kindergarten Room), Kindergarten School Age Room, Library, and School Age Playground. LPAs toured the facility for any health and safety hazards with D1. LPAs observed the classrooms to be clean and free of debris. There are a variety of age-appropriate toys and furniture present. Bathrooms are available for children to use in a few classrooms and in the lobby near the front desk. Individual cubbies are available for children’s personal storage. LPAs tested and verified the presence of carbon monoxide detectors. There is a fire alarm system running throughout the facility. Fully charged fire extinguishers at least the size of 2A10BC are present in the classrooms. LPAs observed cleaning solution chemicals not locked and stored inaccessible to children in care. LPAs advised D1 to ensure all cleaning solution chemicals are made inaccessible and D1 removed them. LPAs also observed trash bins containing food waste without tightfitting covers. LPAs advised D1 that all trash bins with food waste must have tightfitting covers that are kept on. D1 stated they understood. LPAs observed electrical wires and power outlet strips plugged in and advised D1 to install cord covers to make them inaccessible to children in care. D1 stated they understood. Continued on Page Two

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

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 MARIN COMMUNITY SERVICES (SA)	FACILITY NUMBER: 214005456
	VISIT DATE: 09/04/2025

NARRATIVE

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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).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP

Per D1, the facility provides snacks on school days as well as breakfast and lunch on full days. Children refill their personal water bottles from water bottle refill stations and Brita filters located in the classrooms as needed.

This facility provides Incidental Medical Services – IMS. LPAs 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/.

LPAs observed the outdoor area to be free of debris and other loose articles. There are age-appropriate toys and equipment present. There is a playground structure rated for children ages 5-12 years old. There is shade from trees and tarps for children to rest under. Children bring their water bottles with them when playing outdoors. The outdoor area is enclosed by a fence that is at least four feet high. There are no swimming pools or other similar bodies of water on site.

Continued on Page Three

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

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 MARIN COMMUNITY SERVICES (SA)	FACILITY NUMBER: 214005456
	VISIT DATE: 09/04/2025

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LPAs reviewed five staff files and five children’s files. LPAs observed there to be at least one teacher present with current Pediatric CPR/First Aid training. Staff’s Mandated Reporter Training certificates were all current and available for review. The facility uses Student Information Systems (SIS) by Hubbe Systems for sign-ins and sign-outs. All required postings were observed to be posted and accessible for review by the front entrance.

D1 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.

D1 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.

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.

See LIC9102-TV for technical violations issued today regarding cleaning solution chemicals, electrical wires, trash bins, and supervision.

No deficiencies were cited on today’s visit, 9/4/2025.

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

Exit interview conducted and report was reviewed with the Program Director, Emily Bugos.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC809 (FAS) - (06/04)

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