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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801635
Report Date: 01/14/2021
Date Signed: 01/15/2021 11:59:38 AM

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:HEALDSBURG SENIOR LIVING COMMUNITYFACILITY NUMBER:
496801635
ADMINISTRATOR:ROB MATTHEWSFACILITY TYPE:
740
ADDRESS:725 GROVE STREETTELEPHONE:
(707) 433-4877
CITY:HEALDSBURGSTATE: CAZIP CODE:
95448
CAPACITY:82CENSUS: DATE:
01/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Acting Administrator, Amanda NorthTIME COMPLETED:
03:00 PM
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Licensing Program Analyst Willis and Licensing Program Manager DeBenedetti met with Acting Administrator, Amanda North via teleconference due to Covid-19 precautions.

Teleconference visit was conducted so CCL representatives could observe compliance with the facility Mitigation Plan. The following observations were made:
  • Facility has cohorted Covid positive residents to minimize exposure
  • PPE stations are set up outside of the Covid positive unit as well as throughout the unit
  • Facility has started documenting when they disinfect the facility to assist with infection control
  • Trash cans in resident bedrooms did not have lids. *Acting Administrator indicated that they have been ordered


Staffing was discussed and LPA requested a detailed explanation of current staffing. LPA also requested documentation that staff have been trained on the facility's Mitigation Plan. Acting Administrator indicated verbally that staff were trained.

No deficiencies were cited during this inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria WillisTELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
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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