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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216800977
Report Date: 05/29/2024
Date Signed: 05/29/2024 02:03:48 PM


Document Has Been Signed on 05/29/2024 02:03 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:WINDCHIME OF MARINFACILITY NUMBER:
216800977
ADMINISTRATOR:MARY MCCLUREFACILITY TYPE:
740
ADDRESS:1111 SIR FRANCIS DRAKE RDTELEPHONE:
(415) 482-4100
CITY:KENTFIELDSTATE: CAZIP CODE:
94904
CAPACITY:55CENSUS: 26DATE:
05/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Ravi Banwait, Business Office DirectorTIME COMPLETED:
02:00 PM
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License Program Analyst (LPA) Shannan Hansen arrived at 8:45 AM to conduct an unannounced annual inspection and was greeted by staff. Business Office Director (BOD) Ravi Banwait arrived shortly after. LPA spoke with administrator on the phone, who was unable to attend inspection, authorized BOD to sign report. There is a total of 26 dementia residents and 5 residents under Hospice care.

Beginning at approximately 9:00 AM, LPA toured the community with Care Coordinator, Gisselle Benavides & BOD. The tour of the facility included nine resident apartments, activity rooms, salon, dining rooms, kitchen and outdoor patios. All interior parts of the facility were found to be a comfortable temperature measuring between 75 to 78 degrees F. Exits and pathways were free from obstructions other then third floor east fire exit door. Delayed egress doors have audible alarms when doors are opened without access codes. Hot water temperature measured within regulation of 105 to 120 degrees F in nine of nine rooms tested. Bathrooms contained necessary grab bars and showers contained non-slip floor/mats. LPA observed at least a minimum of a 2 day supply of perishable and 7 day supply of non-perishable food necessary for residents in care. Food was found to be handled and stored in a safe manner. Dining rooms and kitchenettes were inspected. Menus with snack and beverages are available to residents. Activity schedules are posted. Facility has multiple indoor and outdoor sitting areas and a private dining area.



LPA initiated a file review of five resident files and five personnel files but were unable to complete. LPA was also unable to review medication, and conduct remaining interviews and will return at a later date to complete annual inspection.

No citations given at today's inspection

SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024
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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