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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493004498
Report Date: 03/25/2024
Date Signed: 03/25/2024 01:06:02 PM


Document Has Been Signed on 03/25/2024 01:06 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: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: 40DATE:
03/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:56 AM
MET WITH:Dawn O'MalleyTIME COMPLETED:
12:54 PM
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An unannounced case management visit to the facility was made today by Licensing Program Analyst (LPA) Y. Yang to follow up on on unusual incident report (UIR) received by the Department on 03/19/24. The LPA spoke with the center director, Dawn O'Malley regarding the incident report to obtain additional information and provided technical assistance.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the center director, Dawn O'Malley. 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: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2024
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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