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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009469
Report Date: 10/22/2026
Date Signed: 10/22/2026 10:44:25 AM

Document Has Been Signed on 10/22/2026 10:44 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:NORTH BAY CHILDRENS CENTER FITCH MOUNTAINFACILITY NUMBER:
493009469
ADMINISTRATOR/
DIRECTOR:		SMITH, JOLEYNNFACILITY TYPE:
850
ADDRESS:520 MONTE VISTA AVE. RM 6-9TELEPHONE:
(707) 473-4382
CITY:HEALDSBRUGSTATE: CAZIP CODE:
95448
CAPACITY: 66TOTAL ENROLLED CHILDREN: 54CENSUS: 33DATE:
10/22/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:39 AM
MET WITH:Joleynn SmithTIME VISIT/
INSPECTION COMPLETED:
10:58 AM
NARRATIVE
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An unannounced case management visit was made to the facility today by Licensing Program Analyst (LPA) Jessica Gaumann in response to a self-reported Unusual Incident Report (UIR) which was reported to the Department on 10/14/26. During today’s follow-up visit, LPA met with Director (D1) Joleynn Smith. LPA conducted interviews and made observations.

Interviews with D1 and staff (S1 and S2) revealed that on 10/12/26, a child (C1) was left without supervision at the facility. S1 performed a student attendance count by matching each child’s name to their face and could not locate C1 in the play yard. S2 located C1 within approximately one minute in a classroom by themselves and brought them back outside.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. A notice of site visit was given and must remain posted for 30 days. This report was read and reviewed with Joleynn Smith.

Melinda Mohr
Jessica Gaumann
DATE: 10/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2026
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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: NORTH BAY CHILDRENS CENTER FITCH MOUNTAIN
FACILITY NUMBER: 493009469
VISIT DATE: 10/22/2026
NARRATIVE
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NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Jessica Gaumann
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/22/2026 10:44 AM - It Cannot Be Edited


Created By: Jessica Gaumann On 10/22/2026 at 10:14 AM
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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: NORTH BAY CHILDRENS CENTER FITCH MOUNTAIN
FACILITY NUMBER: 493009469

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/29/2026
Section Cited
CCR
101229(a)(1)

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101229(a) The licensee shall provide care and supervision as necessary to meet the children's needs (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation.

This requirement was not met as evidenced by:
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Director (D1) stated that the facility's supervision policies have been updated and new policies were reviewed with all staff during the all staff meeting on 10/14/26. The facility’s Plan of Operation has been updated to include that all children’s belonging are moved outside for easier pick-up. Bells have been placed
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Based on interviews, Director and 2 staff (S1, S2) stated a child (C1) was able to leave the play yard and go inside a classroom without staff supervision, which poses/posed an immediate health, safety or personal rights risk to persons in care.
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on multiple exits around the facility. Staff schedules have been adjusted to have a higher staff presence at pick-up time. D1 stated she will submit a written statement of all procedure updates regarding supervision polices to LPA Gaumann via email: jessica.gaumann@dss.ca.gov by 10/29/26.

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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.
Melinda Mohr
NAME OF LICENSING PROGRAM MANAGER:
Jessica Gaumann
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2026


LIC809 (FAS) - (06/04)
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