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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336403366
Report Date: 01/26/2021
Date Signed: 01/27/2021 10:27:40 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:WINDSOR COURT ASSISTED LIVINGFACILITY NUMBER:
336403366
ADMINISTRATOR:BRITTANY HOLMFACILITY TYPE:
740
ADDRESS:201 S. SUNRISE WAYTELEPHONE:
(760) 327-8351
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:130CENSUS: DATE:
01/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Robert BernalTIME COMPLETED:
02:20 PM
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LPA Susan Parker conducted a Case Management visit via FaceTime, due to COVID-19, to follow up on a confirmation of removal for Person #1 and Person #2. LPA Parker met with Business Office Manager Robert Bernal and explained the purpose of the visit.

Mr. Bernal said Person #1 and Person #2 never started working at the facility. LPA Parker has verified that Person #1 and Person #2 do not work, nor have they ever worked at Windsor Court Assisted Living.

Verification of removal is complete.

Exit interview was conducted with Mr. Bernal and a copy of this report was provided to him.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Susan ParkerTELEPHONE: (951) 897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2021
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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