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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490104221
Report Date: 01/15/2025
Date Signed: 01/15/2025 02:19:11 PM

Document Has Been Signed on 01/15/2025 02:19 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:WHISTLER HOUSE, THEFACILITY NUMBER:
490104221
ADMINISTRATOR/
DIRECTOR:
HARTWIG, TERRY LYNNFACILITY TYPE:
735
ADDRESS:4642 WHISTLER AVENUETELEPHONE:
(707) 585-0606
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY: 4CENSUS: 3DATE:
01/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:09 PM
MET WITH:Terry L Hartwig (Licensee)TIME VISIT/
INSPECTION COMPLETED:
02:34 PM
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Licensing Program Analyst, (LPA) Cuadra, arrived unannounced to conduct an Annual Required Inspection and met Licensee Terry Hartwig. Clients were attending to day program at the time of visit.

LPA/Licensee initiated a tour of the facility at 12:30pm and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Client bedrooms and shared bathroom are located in a unit separate from the house. There is an intercom system installed if clients need assistance. Client rooms were furnished per regulation. Extra hygiene products and linens were available. Water temperature in bathrooms used by clients measured at 118.4 degrees F. Cabinet located under the kitchen sink containing cleaning supplies was locked. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked. Fire extinguisher was charged as of August, 2024. Smoke detectors located throughout the facility and carbon monoxide detector were tested and operational. Most recent fire drill was conducted 12/13/2024. Cash resources reviewed. Annual fees are current. Contact information was reviewed.

File review was initiated at 1:00pm. Two staff files and three client files were reviewed. Staff have required First Aid certificates. Administrator Certificate for Licensee/Administrator Terry Hartwig, 7034429735, expired on 12/18/24. Licensee is currently not on the Department's Certification Unit lists, but they were able to show proof of mailed documents as of 9/23/24 with an USPS receipt. Medications and medication records were reviewed. Required postings were observed.

Licensee submitted updates of the following documents: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and surety bond.
No deficiencies cited during this inspection. Exit interview conducted with Licensee and copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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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