<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010192
Report Date: 03/20/2024
Date Signed: 03/20/2024 04:26:04 PM

Document Has Been Signed on 03/20/2024 04:26 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-FORESTVILLEFACILITY NUMBER:
493010192
ADMINISTRATOR:PALOMA ESCALANTE DE BURROWFACILITY TYPE:
850
ADDRESS:6321 HWY 116TELEPHONE:
(707) 887-2279
CITY:FORESTVILLESTATE: CAZIP CODE:
95436
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 5DATE:
03/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Paloma Escalante De BurrowTIME COMPLETED:
04:30 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
Licensing Program Analyst (LPA) Glenn Ouye met with the Site Supervisor regarding a self reported incident which occurred on February 29, 2024. Child (C1) was found immediately outside of the rear door which leads into the outdoor activity area. The child was in the classroom and went out of the rear door. A teacher who was returning to the classroom saw C1 standing outside of the rear door and brought C1 into the classroom. The department was notified via a phone call to the Officer of the Day and the Unusual Incident Report was emailed to the department as well. It does not appear that there was an immediate risk to the child's health and safety and the program as instituted the following to prevent a reoccurrence of the incident.

The facility has installed door alarms on the front and rear doors to alert staff if a door is opened. The Site Supervisor indicated that face to name student identification is done during transitions to and from the classroom. Staff are also maintaining a greater level of line of sight supervision of C1. Site Supervisor is in discussion with the school to add alarms to outdoor play area gates to alert teachers if a child is opening one of the gates.

No deficiency cited during the visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1