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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005480
Report Date: 08/18/2022
Date Signed: 08/18/2022 09:42:17 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/25/2022 and conducted by Evaluator Marie Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20220525094855
FACILITY NAME:NORTH BAY CHILDREN'S SCHOOLFACILITY NUMBER:
214005480
ADMINISTRATOR:SISSECK, KRISTINAFACILITY TYPE:
830
ADDRESS:940 C ANNEXTELEPHONE:
(415) 883-6222
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:28CENSUS: 9DATE:
08/18/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nicole PorterTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
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9
Child sustained fracture while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced complaint inspection to deliver the finding of the above allegation as investigated by the Department’s Investigations Branch (IB). LPA met with Director Nicole Porter and explained purpose of inspection.

During the course of the investigation, IB Investigator Sonia Boyal conducted interviews with Director, staff, child’s guardian, crossing reporting agencies, and other relevant parties. IB Investigator also obtained relevant documentation.

Although the allegation that a child sustained fracture while in care may have happened or may be valid, based on the information obtained by IB Investigator Boyal, there is not a preponderance of evidence to prove the alleged violation did or did not occur, there the allegation is found to be UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with Director Nicole Porter. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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