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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880707
Report Date: 07/01/2022
Date Signed: 07/01/2022 01:16:21 PM

Document Has Been Signed on 07/01/2022 01:16 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:WINDROSE HOUSE, THEFACILITY NUMBER:
361880707
ADMINISTRATOR:ELIZABETH GONZALEZFACILITY TYPE:
735
ADDRESS:7411 WINDROSE DRTELEPHONE:
(909) 280-3285
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 4CENSUS: 4DATE:
07/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Crystal Guzman - Care providerTIME COMPLETED:
01:19 PM
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Licensing Program Analyst (LPA) Anna Bueno made an unannounced annual required visit, with an emphasis on infection control. LPA met with two DSP II and four clients. LPA advised staff of the nature of the visit and was granted entry to the facility.

LPA and DSP Guzman toured the facility inside and out. The facility has no bodies of water. The facility has operating smoke alarms and carbon monoxide detector and a charged fire extinguisher. Cleaning supplies and sharps were kept in a safe and locked cabinet. LPA observed at least two (2) days supply of perishable food items and seven (7) days supply of nonperishable food items. The client bedrooms had the required furniture and sufficient lighting. Facility had a supply of additional linen and hygiene items.

LPA Bueno observed one central entry point and sign-in policy has been designated for screening. Routine symptom screening has been initiated at entry for all visitors. Client temperatures are taken daily. All clients have at least a 30 day supply of medications. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate and quarantine clients, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas.

LPA Bueno observed no health and safety concerns at the time of visit. The facility appears to be meeting operational compliance. Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report was discussed and a copy of this report was provided to Ms. Guzman at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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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