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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010190
Report Date: 03/13/2025
Date Signed: 03/13/2025 10:23:54 AM

Document Has Been Signed on 03/13/2025 10:23 AM - 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:YWCA PRESCHOOL-SEBASTOPOLFACILITY NUMBER:
493010190
ADMINISTRATOR/
DIRECTOR:		RIVAS NINO, NATHALIEFACILITY TYPE:
850
ADDRESS:466 JOHNSON STREETTELEPHONE:
(707) 829-2160
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 13DATE:
03/13/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Nathalie Rivas NinoTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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An unannounced Case Management inspection was conducted at the facility by Licensing Program Analyst (LPA) Selena Mariani in response to a self reported Unusual Incident Report (UIR) received 01/13/2025 involving an interaction between a staff and a child. During today's visit, LPA met with Site Supervisor (SS) Nathalie Rivas Nino to discuss the incident.

LPA obtained documents, conducted interviews with SS and Staff 1 (S1). At this time there is no basis for citation.

There were no Title 22 violations cited during today's case management visit. The Notice of Site Visit shall be posted for 30 days.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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