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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801426
Report Date: 08/22/2024
Date Signed: 08/22/2024 02:20:42 PM

Document Has Been Signed on 08/22/2024 02:20 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:THRUSHWING HOMEFACILITY NUMBER:
496801426
ADMINISTRATOR/
DIRECTOR:
DEBBIE MILLERFACILITY TYPE:
735
ADDRESS:128 THRUSHWING AVENUETELEPHONE:
(707) 843-4880
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 4CENSUS: 3DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Debbie Miller (Administrator)TIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Cuadra, arrived unannounced to conduct an Annual Required Inspection and met with Administrator/Licensee, Debbie Miller. Annual fees are current. Contact information was reviewed. Licensee previously have submitted updates of required documentation to change administrators except a copy current surety bond and control of property (not later than 9/6/24).

LPA/Administrator initiated a tour of the facility at 2:00 pm and made the following observations: No clients were home during inspection. Facility was a comfortable temperature reading at 74 degrees F. Passageways were free from obstructions. Client rooms were furnished per regulation. Water temperature in client bathroom measured at 112.6 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Cleaning supplies are stored in a cabinet in the laundry room. Laundry room was locked during inspection. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked in a the office. Fire extinguisher was last inspected December 2023. Facility has hardwired smoke detectors located throughout the facility that were tested and operational. Carbon Monoxide detector located in the hallway was tested and operational. Most recent fire drill was conducted March 29, 2024.

File review was initiated at 1:00 pm. Three resident files and three staff files were reviewed. Staff have required First Aid certificates. Administrator Certificate for Administrator, Debbie Miller, 7035344735 expires 2/4/26. Medications and medication records were reviewed. Cash resources were reviewed.

No deficiencies cited during this inspection. Exit interview conducted with Administrator and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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