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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496800179
Report Date: 04/12/2024
Date Signed: 04/12/2024 12:36:26 PM

Document Has Been Signed on 04/12/2024 12:36 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:WINDSOR HOUSEFACILITY NUMBER:
496800179
ADMINISTRATOR/
DIRECTOR:		HALL, DARIANFACILITY TYPE:
735
ADDRESS:1386 SANDERS ROADTELEPHONE:
(707) 838-9489
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 4CENSUS: 3DATE:
04/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:37 AM
MET WITH:Marylis Gachu (DSP)TIME VISIT/
INSPECTION COMPLETED:
12:51 PM
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Licensing Program Analyst (LPA) Cuadra arrived at facility unannounced to conduct a case management was greeted by staff Marylis Gachu. Licensee Darian Hall was unable to come to the facility, but was available by phone and gave authorization for staff to sign the report.

During today's visit, LPA explained to Licensee that this is the second notice letter sent to them after unsuccessful attempts via email and phone on 1/29/24 at 3:08pm and 4/3/24 at 8:46am, regarding their outstanding fees in the amount of $681. Licensee provided proof that their fees are current. LPA confirmed that there are no annual outstanding fees at the moment. Also, LPA suggested to Licensee to submit a request to update their facility contact information including their phone number to the Department.

No deficiencies cited during today's inspection. Exit interview conducted with staff and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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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