Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006543
Report Date: 11/16/2017
Date Signed: 11/17/2017 08:10:14 AM

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 - SCHOOL-AGEFACILITY NUMBER:
493006543
ADMINISTRATOR:SCHEINBERG, MARISAFACILITY TYPE:
840
ADDRESS:1001 A CHERRY STREETTELEPHONE:
(707) 763-6222
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:45CENSUS: 9DATE:
11/16/2017
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:50 PM
MET WITH:Holly MungerTIME COMPLETED:
06:45 PM
NARRATIVE
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A Case Management visit was made to the facility by LPA Y. Yang in response to a self reported Unusual Incident Report received 11/6/2017 involving an absence of supervision resulting in a child wandering away from the outdoor play area to the other side of the school campus. LPA met with teacher Holly Munger and substitute teacher Hilary Schmidt to discuss the allegations. On 11/1/2017, at approximately 12:45pm, a group of children were walking across the blacktop with the site supervisor and staff #3 to pick up additional children. When the group returned to the classroom, the site supervisor conducted a head count and realized child #1 (see LIC811, Confidential Names List) was left behind. The site supervisor went looking for child #1 on the school campus and issued an "all call." According to staff #3, the child was alone outside for approximately 15 minutes and was found walking away from staff #2's classroom. The site supervisor then escorted child #1 back to the child's classroom. Staff notified the child's parent of the incident on the day it occurred. This incident constitutes an absence of supervision and is an immediate risk to the child in care.
This report was read and discussed with teacher Holly Munger. Appeal rights were provided.
Notice of Site Visit shall be posted for 30 days from today's visit.

The following Type A violation of the California Code of Regulations, Title 22; Division 12, Chapter 1 were cited: see LIC 809D.
Reports citing Type A violations are to be provided to parents/guardians of children currently in care of the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. During today's visit a copy of the licensee's appeal rights and Form LIC9224, Acknowledgement of Receipt of Licensing Reports were provided to the licensee.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2017
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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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 - SCHOOL-AGE
FACILITY NUMBER: 493006543
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/17/2017
Section Cited
CCR
101229(a)(1)
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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).

A child wandered away from the group and was left without supervision.




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Area director referred all NBCC Cherry Valley Staff back to NBCC's "Supervision of Children" policy for review. Staff were also reminded to actively update classroom roster and refer to the roster before all transitions to ensure an accurate headcount.


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This poses an immediate risk to the child in care.
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This citation was cleared during today's inspection.
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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) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2017
LIC809 (FAS) - (06/04)
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