Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006542
Report Date: 11/17/2015
Date Signed: 11/17/2015 01:53:12 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: 22DATE:
11/17/2015
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Michelle PanizzeraTIME COMPLETED:
01:45 PM
NARRATIVE
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LPA Debra Willhite was here on another matter and conducted this case management visit. Acting as director was teacher Fabiola Martinez; three other teachers were present.


See LIC 809D; appeal rights given.

NOTICE OF SITE VISIT IS POSTED; IF REMOVED BEFORE 30 DAYS A $100.00 CIVIL PENALTY MAY APPLY.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Debra WillhiteTELEPHONE: (707) 588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2015
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: 11/17/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2015
Section Cited
1596.866a1 H&S
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In addition to other required training, at least one director or teacher at each day care center, and each family day care home licensee who provides care, shall have at least 15 hours of health and safety training. This includes pediatric CPR, First Aid, and Preventative Health. Today, when LPA arrived the person designated with responsibility of facility did not have verification of Preventative Health & Safety Training.
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I will make sure that there will always be someone on site who has evidence of the required Preventative Health & Safety.
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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.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Debra WillhiteTELEPHONE: (707) 588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2015
LIC809 (FAS) - (06/04)
Page: 2 of 2