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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008312
Report Date: 12/05/2019
Date Signed: 12/05/2019 11:22:05 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:MONTES, MARIA FCCHFACILITY NUMBER:
493008312
ADMINISTRATOR:MONTES, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 837-9251
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:14CENSUS: 12DATE:
12/05/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Maria MontesTIME COMPLETED:
11:30 AM
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), Leticia Rosales-Meza conducted an unannounced case management visit in follow up to the recent Public Safety Power Shutoffs (PSPS) and fire evacuations. Licensee confirmed there was no significant impact, power shutoff was brief, facility was closed for five days. The facility is observed to be in full operation today with no identified health and safety issues or unmet needs. LPA also verified the most current contact information. No deficiencies cited for areas observed today.

Notice of Site Visit shall be posted for 30 days from today's visit
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
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