Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009183
Report Date: 09/06/2016
Date Signed 09/06/2016 12:08:41 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 CHILDRENS CENTER-VALLEY VISTAFACILITY NUMBER:
493009183
ADMINISTRATOR:MCDONALD, PAMALLAFACILITY TYPE:
850
ADDRESS:730 NORTH WEBSTER STREETTELEPHONE:
(707) 778-4762
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:16CENSUS: 10DATE:
09/06/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Tonima HoqueTIME COMPLETED:
12:15 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 Melchisedeck Augustin visited for the purpose of inspecting and measuring rooms because an increase of capacity was requested. The center is situated on the grounds of Valley Vista Elementary School. This center currently is licensed for a capacity of 16 preschool children. The center is requesting an additional 24 preschool children, for a total capacity of 40 preschool children ages 3-TK. The center currently uses room #18 and is requesting approval for room # 33. The Sonoma County Fire Protection conducted a fire clearance on 8/29/16 and a fire clearance was granted for the requested capacity. This program is a Title 5 and Title 22 program. LPA met with the Program Manager. All staff was fingerprint cleared. Ratio and capacity were met
Classroom # 33 appears clean and organized. Napping equipment is stored properly. There were not enough cots for children to nap. The Program Manager stated that 9 additional cots will be ordered. There are 10 preschool children in care today. Ratio was met in classroom #18. Drinking water is readily accessible inside and out. There is a water fountain inside the classroom and 2 water fountains outside for children to drink water. Shade is provided by an awning and large tree. There are 2 bathrooms inside the classroom for the children to use. All toilets and sinks are functional. The sink delivers cold water and is below 120 degrees. The kitchen area is clean and sanitary. There is a sink. The center provides 1 breakfast, lunch and snack. There is functional smoke detector that is hardwired. There is a 3-A:40:BC fire extinguisher that was last serviced on 12/21/2015. There is a functional carbon monoxide detector. All electrical outlets have safety toddler covers. The classroom has 2 exits. The designated Isolation Area is at the Office. The center did not have a First Aid kit inside the class room #33. A Sample menu and an Activities Schedule were not posted. LIC 610, Parents Rights, Personal Rights were posted. The Program Manager stated that a Sign In/Sign Out sheet will be created and located on top of a cubby to sign children in and out. There were no bodies of water observed. The Program Maneger stated that there are no firearms and none was observed by LPA. The playground has more than 75 square footage of outdoor space to accommodate the requested capacity of 40 children. Classroom # 18 and 33 will use intermittent outdoor activities schedules. The playground area has grass to cushion children's falls. The indoor space has more than 35 square footage per child indoor, to meet the request of an additional capacity of 24, to equal a total capacity of 40 children.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2016
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 CHILDRENS CENTER-VALLEY VISTA
FACILITY NUMBER: 493009183
VISIT DATE: 09/06/2016
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
26
27
28
29
30
31
32
The class room has a working telephone.The is enough cubby space for the children to store their belongings. This facility provides Incidental Medical Services. LPA reviewed storage of medication and equipment supplies, and reviewed children's, personnel and Administrative records. The facility does not have documentation of staff who underwent IMS training. LPA provided Incidental Medical Services handout to the Program Manager. The following items must be corrected and submitted before licensure.

Obtain a First Aid Kit.
Obtain 9 additional cots for children to nap.
Post Sample Menu and Activities Schedule.
Complete and post Earthquake Preparedness Guide
Cardboard debris inside the class room needs to be removed.

The Program Manager stated that the items will be corrected by the end of the day.
The capacity increase is will be granted for 40 preschool children effective date 09/12/2016.

Notice of Site Visit is posted and will remain posted for 30 days
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2016
LIC809 (FAS) - (06/04)
Page: 2 of 2