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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010190
Report Date: 06/24/2024
Date Signed: 06/24/2024 12:26:42 PM

Document Has Been Signed on 06/24/2024 12:26 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:YWCA STARS PRESCHOOL-SEBASTOPOLFACILITY NUMBER:
493010190
ADMINISTRATOR/
DIRECTOR:		RIVAS NINO, NATHALIEFACILITY TYPE:
850
ADDRESS:466 JOHNSON STREETTELEPHONE:
(707) 869-8106
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY: 22TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
06/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:09 AM
MET WITH:Nathalie Rivas Nino, Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
12:26 PM
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An unannounced case management visit was made to the facility today by Licensing Program Analyst (LPA) Y. Yang to provide technical assistance and follow-up on an incomplete written unusual incident Report (UIR) submitted by the facility on 06/21/24. During today's case management visit, the LPA met with the facility's site supervisor, Nathalie Rivas Nino. During this visit, the LPA provided technical assistance on Title 22 regulations and best practices recommendations.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the site supervisor, Nathalie Rivas Nino. There were no Title 22 deficiencies cited during today's inspection.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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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