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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336403366
Report Date: 12/20/2021
Date Signed: 12/20/2021 02:39:44 PM

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:PATRICK MCADOO MORTONFACILITY TYPE:
740
ADDRESS:201 S. SUNRISE WAYTELEPHONE:
(760) 327-8351
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:130CENSUS: 102DATE:
12/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Patrick McAdoo-MortonTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Jesse Gardner made an unannounced case management visit and met with Administrator Patrick McAdoo-Morton and explained the purpose of the visit.

The Department received a Special Incident Report (SIR) on December 17, 2021 pertaining to Resident One (R1) engaging in inappropriate behavior with Resident Two (R2).

At the time of the visit, through record review of the resident involved, as well as staff being in the area at the time of the incident, it was determined that there were no violations of Title 22, thus no citations were issued.

Facility followed protocol and the investigation is complete.

No deficiencies observed at this time.

An exit interview was conducted with Administrator Patrick McAdoo-Morton and a copy of this report along with LIC 811 was provided.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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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