214005524-5-21-2026-05-CC-NTRN-DUAQPQ-20260521122108

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005524
Report Date: 05/21/2026
Date Signed: 05/21/2026 12:21:36 PM

Document Has Been Signed on 05/21/2026 12:21 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	NORTH BAY CHILDREN'S CENTER OLIVE		FACILITY NUMBER:	214005524
ADMINISTRATOR/ DIRECTOR:	CHRISTY CHUM		FACILITY TYPE:	850
ADDRESS:	620 OLIVE AVENUE		TELEPHONE:	(415) 883-6222
CITY:	NOVATO	STATE: CA	ZIP CODE:	94945
CAPACITY: 22	TOTAL ENROLLED CHILDREN: 17	CENSUS: 10	DATE:	05/21/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:50 AM
MET WITH:	Director, Christy Chum		TIME VISIT/ INSPECTION COMPLETED:	12:35 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	On May 21, 2026 at approximately 9:50AM, Licensing Program Analyst (LPA) Nicole Tran conducted an unannounced, annual inspection and met with Director, Christy Chum, and disclosed the purpose of the visit. Present during the inspection was Director, 5 staff, and 10 preschool age children. The facility operates in a portable on the campus of Olive Elementary School. Hours of operation are Monday to Friday from 7:30AM to 5:00PM. LPA inspected the portable for health and safety hazards. LPA observed a variety of age-appropriate toys that are in good condition. There is dramatic play equipment and manipulatives to encourage free play and imagination. There were also spaces for other activities, eating, and rest and relaxation. Age-appropriate furniture was observed to be maintained in good condition, free of sharp, loose or pointed parts. LPA observed cabinets and drawers to be locked or had a child safety device installed. Storage for children's belongings are located inside the classroom, labeled with their names. LPA observed electrical outlets in classrooms to be made inaccessible with child safety covers. Facility is equipped with a fully charged fire extinguisher, first aid kits, smoke/carbon monoxide detectors, and a fire alarm system. The isolation area for children not feeling well and are awaiting pick up is in the teachers’ area. Chemicals, poisons, and cleaning solutions have been made inaccessible to children. Continued on Page Two

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NORTH BAY CHILDREN'S CENTER OLIVE	FACILITY NUMBER: 214005524
	VISIT DATE: 05/21/2026

NARRATIVE

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Restroom for children's use was observed to be in working condition. LPA observed children's restroom to have age-appropriate toileting equipment and hand-washing materials. Per Director, parents provide diapers/wipes and LPA observed them to be appropriately stored. The facility has additional diapers/wipes if needed. The bathroom has a trash can with a tight-fitting lid for solid waste.

Children sleep on cots. Sheets are provided by the facility while blankets are provided by families. Per Director, the facility launders all sheets and blankets are sent home to be washed weekly. LPA observed children’s bedding to be individually stored so that no child’s used bedding comes into contact with other bedding.

The facility provides a full food service that includes breakfast, lunch, and afternoon snacks. Lunch is provided by Olive Elementary School. Food menus are posted by the front entrance. Drinking water is available from a filtered water dispenser and from water bottles. Children’s water bottles are brought out during outdoor play time. Per Director, there are zero currently enrolled children that require prescription medication.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code section 1597.16.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP.).

LPA verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information).

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NORTH BAY CHILDREN'S CENTER OLIVE	FACILITY NUMBER: 214005524
	VISIT DATE: 05/21/2026

NARRATIVE

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With Director, LPA inspected the outdoor area for health and safety hazards. Outdoor area is fully enclosed and fully fenced. Trees, umbrellas, and structures provide shade for children to rest under. Age-appropriate toys, activity tables, and equipment were observed to be in good condition. There are rubber mats underneath a slide to cushion falls. A small trampoline is also available for children’s use on the grass area. LPA observed one child using it at a time with a teacher supervising close by. There is a sandbox with a cover to prevent debris and loose articles from falling in when not in use. Per Director, the sandbox is inspected daily before use. There is also a locked shed for outdoor storage. LPA did not observe any pools, spas or bodies of water on site.

Licensing documents are properly posted and available for review by the front door. The facility conducts emergency disaster drills with Olive Elementary School that are documented and maintained. The last disaster drill conducted was on April 30, 2026. The facility utilizes an electronic sign in/out record via an electronic application. Per Director, all parents and guardians have unique PIN identifiers to sign children in and out.

LPA reviewed 6 random children's records. Children's files were observed to be complete and included emergency information and consent for emergency medical authorization. LPA reviewed 4 staff files and observed them to be complete. There is at least one staff member with current pediatric CPR/First Aid training. Staff files also include a current Mandated Reporter certification.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NORTH BAY CHILDREN'S CENTER OLIVE	FACILITY NUMBER: 214005524
	VISIT DATE: 05/21/2026

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiencies were issued during today’s visit, May 21, 2026. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Christy Chum.

NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

LIC809 (FAS) - (06/04)

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