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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801426
Report Date: 07/20/2023
Date Signed: 07/20/2023 02:50:54 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/20/2023 02:50 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:THRUSHWING HOMEFACILITY NUMBER:
496801426
ADMINISTRATOR:KRYSTAL AMBRECHTFACILITY TYPE:
735
ADDRESS:128 THRUSHWING AVENUETELEPHONE:
(707) 843-4880
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 4CENSUS: 3DATE:
07/20/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator, Krystal AmbrechtTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced to conduct a Case Management Annual Continuation inspection and met with Administrator, Krystal Ambrecht.

LPA has returned to review staff files and client cash resources that were not available during the Annual Required inspection dated 6/6/2023.

No deficiencies cited during this inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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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