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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005620
Report Date: 06/15/2022
Date Signed: 06/15/2022 01:38:11 PM

Document Has Been Signed on 06/15/2022 01:38 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:NORTH BAY CHILDREN'S CENTER - LYNWOODFACILITY NUMBER:
214005620
ADMINISTRATOR:SISSICK, KRISTINAFACILITY TYPE:
840
ADDRESS:1320 LYNWOOD DRIVETELEPHONE:
(415) 883-6222
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
06/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Kristina SissickTIME COMPLETED:
11:39 AM
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On June 15, 2022, Licensing Program Analyst (LPA) Sheran Lo met with applicant Kristina Sisseck for a scheduled Relocation Pre-Licensing Inspection. The applicant is requesting 20 children (ages 2 years to entry into first grade) for temporary operation. The facility will operate Monday-Friday; 7:30AM to 4:30PM. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity.

Indoor: There is one classroom that will be used for the program and the following square footage was calculated for the room. Total useable indoor square footage is 802 sq ft divided by 35 sq ft equals 22.914 children. The indoor space for children is observed today to be clean. There are 2 toilets (30 capacity) and 2 sinks (30 capacity) accessible for children’s use. Bathrooms are located inside and outside of the classroom. The bathrooms were observed to be clean and no health and safety hazards. Sinks accessible to children deliver water that is no warmer than 120 degrees.

Outdoor: The outdoor area measures 7,200 sq ft allowing for a total of 96 children. The outdoor area to be used is enclosed by at least a four-foot fence and observed to be clean and safe. Shade is provided by building structure.

LPA Lo will recommend licensure of this facility for a capacity of 20 children once the following is received:



-FIRE CLEARANCE (STD 850)

-Provide photos of classroom set up

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2022
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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