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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213000763
Report Date: 01/04/2022
Date Signed: 01/04/2022 04:36:43 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/04/2022 04:36 PM - It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:NORTH BAY CHILDREN'S CENTER-INFANTFACILITY NUMBER:
213000763
ADMINISTRATOR:KRISTINA SISSECKFACILITY TYPE:
830
ADDRESS:932 C STREETTELEPHONE:
(415) 883-6222
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 0DATE:
01/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Jennifer Schlager, Laura Brown, & Kristina SisseckTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Haydee Caliboso arrived at the facility and met with Jennifer Schlager (Site Supervisor), Laura Brown (Area Manager), and Kristina Sisseck (VP of Operations) for unannounced required annual inspection. However, the facility is currently not providing care. The building is currently under construction. The program has requested to go inactive status starting today 1/4/2022 until 07/15/2023. LPA received notice of request for inactive status and LIC 9211 on 1/4/2022. LPA instructed VP of Operations and Site Supervisor to inform CCLD once the program is ready to resume care.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2022
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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