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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 126803772
Report Date: 08/17/2021
Date Signed: 08/17/2021 01:51:14 PM

Document Has Been Signed on 08/17/2021 01:51 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:WINDSONGFACILITY NUMBER:
126803772
ADMINISTRATOR:CECIL P. WILSON IIIFACILITY TYPE:
735
ADDRESS:2220 MYRTLE AVENUETELEPHONE:
(707) 798-6319
CITY:EUREKASTATE: CAZIP CODE:
95502
CAPACITY: 20CENSUS: 18DATE:
08/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Cecil WilsonTIME COMPLETED:
02:00 PM
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At approximately 11:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a case management visit in regards to a request to increase capacity from 20 to 25. LPA met with Director Cecil Wilson and toured the facility. The request is for an increase of 5. Facility sketch has been updated to reflect the additional space for client use. Staffing plans have been created to ensure observation of clients. Medication procedures are in place and clients will receive meals in the main dining room. Records are secure.

Facility has received a clearance from the fire marshal.

Capacity increase approved.

No citations issued.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2021
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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