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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005479
Report Date: 02/07/2024
Date Signed: 02/07/2024 04:36:07 PM

Document Has Been Signed on 02/07/2024 04:36 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:NORTH BAY CHILDREN'S SCHOOLFACILITY NUMBER:
214005479
ADMINISTRATOR:SISSECK, KRISTINAFACILITY TYPE:
850
ADDRESS:940 C STREET ANNEXTELEPHONE:
(415) 883-6222
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 8DATE:
02/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Nicole PorterTIME COMPLETED:
04:45 PM
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On February 7, 2024, Licensing Program Analyst (LPA) Garcia made an unannounced case management visit to the child day care facility listed above and met with director, Nicole Porter and later joined by VP of programs, Kristina Sisseck. Purpose of the visit was explained to the director. The case management visit is from a self reported incident that occurred on January 18, 2024. The facility had 8 children and 6 teachers in the preschool program and 4 children and 5 teachers in the infant program.

On the day of the incident, the mother of the child informed the facility that her child had blood in her urine and underwear after leaving their care. The mother sought medical treatment and according to the the doctor the mother communicated with the school director that Urinary Tract Infection and other health concerns are ruled out. According to the Unusual Incident Report, there is a visible cut near the child's private area. The parent decided to keep the child at home and remove her from the program, out of concern and feeling uncomfortable. The facility conducted an internal investigation and kept the communications with the parent. LPA Garcia interviewed both directors regarding the incident and documents of all the information gathered with their internal investigation is obtained.

No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

A copy of this report was given to the Licensee and a site visit notification must be posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with Site Director, Nicole Porter and VP of Programs, Kristina Sisseck.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2024
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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