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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496800179
Report Date: 08/17/2021
Date Signed: 08/17/2021 11:26:03 AM

Document Has Been Signed on 08/17/2021 11:26 AM - 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:WINDSOR HOUSEFACILITY NUMBER:
496800179
ADMINISTRATOR:HALL, DARIANFACILITY TYPE:
735
ADDRESS:1386 SANDERS ROADTELEPHONE:
(707) 838-9489
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 4CENSUS: 3DATE:
08/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Darian HallTIME COMPLETED:
11:30 AM
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Licensing Program Analyst Leibert arrived unannounced for the purpose of following up on a reported incident of alleged sexual abuse occurring at the facility. The alleged incident occurred between two clients residing in the facility. LPA met with the Administrator and staff and discussed the situation. LPA reviewed records and took statements. The following determinations were made: The incident was not witnessed. The subject client of the abuse, C1, reported the incident to staff the morning following the incident, which occurred in the middle of the night. Law enforcement was called and took a report but did not arrest the suspect, C2. Administrator made arrangements to have the client removed and placed with a relative in another state the same day. An eviction action was put in place. Staffing was adequate at the time of the incident.


No citations issued today.
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2021
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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