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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493004498
Report Date: 09/19/2019
Date Signed: 09/24/2019 09:08:52 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:WINDSOR CHRISTIAN ACADEMY - P/SFACILITY NUMBER:
493004498
ADMINISTRATOR:O'MALLEY, DAWNFACILITY TYPE:
850
ADDRESS:10285 STARR ROADTELEPHONE:
(707) 838-3084
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:109CENSUS: 67DATE:
09/19/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:57 AM
MET WITH:Dawn O'MalleyTIME COMPLETED:
12:48 PM
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A case management visit was made to the facility by Licensing Program Analyst (LPA) Y. Yang to answer additional questions from the center director Dawn O' Malley regarding an agency initiated case closure for adult A1. The Department has ceased processing the background check for A1. The center director stated that A1 was never an employee at the preschool and was not ever present at the preschool. The center director stated that A1 is associated to the First Baptist Church of Windsor, which shares the same property as Windsor Christian Academy Preschool but is a different entity.

During today's visit, an updated facility staff roster was obtained from the center director.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
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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