<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
079201175
Report Date:
07/22/2022
Date Signed:
07/22/2022 11:04:35 AM
Document Has Been Signed on
07/22/2022 11:04 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
CCLD Regional Office
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
WINDERMERE AT WHITMAN
FACILITY NUMBER:
079201175
ADMINISTRATOR:
WARD, WHITNEY
FACILITY TYPE:
740
ADDRESS:
1921 WHITMAN RD.
TELEPHONE:
(415) 710-5169
CITY:
CONCORD
STATE:
CA
ZIP CODE:
94518
CAPACITY:
6
CENSUS:
0
DATE:
07/22/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:25 AM
MET WITH:
Whitney Ward, applicant-licensee
TIME COMPLETED:
11:15 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) J. Clancy-Czuleger conducted an announced Component III Training. Component III was attended by Whitney Ward (applicant-licensee).
LPA J. Clancy-Czuleger presented the training via Power Point presentation and had a discussion with applicants.
Exit interview conducted and copy of this report provided at the conclusion of the training
SUPERVISORS NAME
:
Harpreet Humpal
LICENSING EVALUATOR NAME
:
Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
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