Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006542
Report Date: 08/07/2015 12:00:00 AM
Date Signed: 08/18/2015 02:08:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:NORTH BAY CHILDREN'S CENTER P/S - MCDOWELLFACILITY NUMBER:
493006542
ADMINISTRATOR:MICHELLE PANIZZERAFACILITY TYPE:
850
ADDRESS:405 SOUTH MCDOWELLTELEPHONE:
(707) 763-2000
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY:39CENSUS: 1DATE:
08/07/2015
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Kimberlie Milus & Michelle PanizzeraTIME COMPLETED:
04:35 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
LPA Debra Willhite was here on another matter and conducted this case management visit.

See LIC 809D for deficiency. Appeal rights are given.

Notice of Site Visit is posted; if removed before 30 days a $100.00 civil penalty may apply.

SUPERVISOR'S NAME: Linda WalkerTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Debra WillhiteTELEPHONE: (707) 588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2015
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: NORTH BAY CHILDREN'S CENTER P/S - MCDOWELL
FACILITY NUMBER: 493006542
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2015
Section Cited
1596.841
1
2
3
4
5
6
7
Each child day care facility shall maintain a current roster of children who are provided care in the facility. Today there is one child attending and enrolled since May who was not on the roster.
1
2
3
4
5
6
7
The roster was updated during the visit clearing this deficiency.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Linda WalkerTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Debra WillhiteTELEPHONE: (707) 588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2015
LIC809 (FAS) - (06/04)
Page: 2 of 2