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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490103579
Report Date: 02/18/2025
Date Signed: 02/18/2025 03:32:36 PM

Document Has Been Signed on 02/18/2025 03:32 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:WOODSIDE WEST SCHOOLFACILITY NUMBER:
490103579
ADMINISTRATOR/
DIRECTOR:		DUMBADSE, DIANAFACILITY TYPE:
850
ADDRESS:2577 GUERNEVILLE ROADTELEPHONE:
(707) 528-6666
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 70TOTAL ENROLLED CHILDREN: 32CENSUS: 26DATE:
02/18/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Diana DumbadseTIME VISIT/
INSPECTION COMPLETED:
03:42 PM
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Licensing Program Analyst (LPA) Amy Strother made an unannounced case management visit to the facility after receiving a report dated 02/06/25, regarding a possible violation of children’s personal rights occurring on 01/27/25. LPA met with Facility Licensee/Director, Diana Dumbadse (D1).

During today’s visit, at total of 26 students were being supervised by 5 staff, operating within the licensed capacity and ratio requirements. LPA interviewed D1, 2 staff, (S1 & S2). Additionally LPA qualified and interviewed 2 children, (C1 & C2).

Based on interviews conducted, it could not be determined if the alleged incident from 01/27/25, resulted in a violation of a child’s personal rights.

There were no Title 22 deficiencies cited during today's inspection.

This report was reviewed and discussed with Licensee/Director, Diane Dumbadse. Appeal Rights were provided.

Notice of Site Visit shall be posted for 30 days from today's visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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