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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801117
Report Date: 02/09/2023
Date Signed: 02/09/2023 03:15:49 PM

Document Has Been Signed on 02/09/2023 03:15 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 RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BIRDIE HOUSEFACILITY NUMBER:
496801117
ADMINISTRATOR:CHRISTINE WOLTERINGFACILITY TYPE:
740
ADDRESS:1402 BIRDIE DRIVETELEPHONE:
(707) 837-9010
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 6CENSUS: 2DATE:
02/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:56 PM
MET WITH:Licensee, Christine WolteringTIME COMPLETED:
03:25 PM
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Licensing Program Analyst Bertozzi arrived unannounced to conduct a Case Management inspection and met with Licensee, Christine Woltering.

Facility was recently vacated so it could be remodeled and remodel is now complete. LPA conducted a tour with the Licensee and observed that required postings are up including but not limited to the Long Term Care Ombudsman poster, CCL Complaint poster and posters regarding Covid-19. Fire extinguishers have been re-hung and exterior doors have alarms.

Facility has admitted two residents and based on LPA observations today may continue normal operation.

No deficiencies cited during this inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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