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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006542
Report Date: 10/09/2025
Date Signed: 10/09/2025 05:04:10 PM

Document Has Been Signed on 10/09/2025 05:04 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:NORTH BAY CHILDREN'S CENTER P/S - MCDOWELLFACILITY NUMBER:
493006542
ADMINISTRATOR/
DIRECTOR:
LUEZA, KRISTIEFACILITY TYPE:
850
ADDRESS:405 SOUTH MCDOWELLTELEPHONE:
(707) 763-2000
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY: 39TOTAL ENROLLED CHILDREN: 30CENSUS: 29DATE:
10/09/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:13 PM
MET WITH:Kristie Lueza, Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
04:29 PM
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An unannounced case management visit was made to the facility by Licensing Program Analyst (LPA) Y. Yang in response to a self-reported, lack of supervision incident involving child C1 that occurred at the facility on the morning of September 12, 2025. During today’s visit, the LPA met with the site supervisor, Kristie Lueza to discuss the incident.

On September 12, 2025, site supervisor, Lueza reported that a child (C1) was inadvertently left unsupervised on the play yard for about two minutes during the outdoor-to-indoor transition. As children lined up to go indoors for breakfast, staff member S1 remained on the playground securing bicycles and did not realize C1 was still present. The teachers inside completed a head count and used walkie-talkies to confirm 17 children were inside and one was outside (with a staff member). S1, however, was not carrying a walkie-talkie and was unaware that a child remained out. After locking up the bikes, S1 entered the building, leaving C1 alone outside. Approximately two minutes later, C1 opened the classroom door and rejoined the group. The site supervisor noted that C1 was not distressed and does not have any known history of hiding from staff. At the time of the incident, there were 18 children and four staff members present.

The site supervisor stated that C1’s authorized representative was notified of the incident, and that the incident was reported to Community Care Licensing as required by regulation. The site supervisor reported that she also interviewed all staff members involved. Beginning September 16, 2025, the facility implemented a revised policy in response. A “face-to-name” checklist is now kept at the classroom door for use during transitions. Each teacher has individually reviewed and signed off on NBCC’s supervision policies, and as a group they completed a review and discussion of the Department’s care and supervision training video during an all staff meeting. The facility now uses prominently posted whiteboards to track staff-child ratios and the number of children present. As part of the ongoing supervision procedure, teachers are required to perform head counts before going outdoors and again when returning indoors, walk through the play yard to confirm no child has been left behind, post supervision guidelines on classroom doors for staff reference, and use walkie-talkie radios to communicate during transitions and outdoor periods. (Continued on LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Yang Yang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2025
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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: NORTH BAY CHILDREN'S CENTER P/S - MCDOWELL
FACILITY NUMBER: 493006542
VISIT DATE: 10/09/2025
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During today’s follow-up visit, the LPA toured the facility and made observations. The LPA noted that teachers were actively supervising all children at that time. The LPA also observed that the zone in which C1 had been left under staff supervision is fully fenced and contains multiple gates before reaching a gate that leads out to the parking lot from the playground.

Although it was corroborated that C1 was left without staff supervision while on the preschool’s fenced play yard, a deficiency citation was not issued today due to the facility’s history of compliance with Title 22 regulations and immediate follow up actions.Technical assistance and best practice recommendations were provided by the LPA during today’s case management visit. This report was read and reviewed with the site supervisor, Kristie Lueza. Notice of site visit shall be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Yang Yang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
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