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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801635
Report Date: 01/21/2022
Date Signed: 01/21/2022 11:26:19 AM

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:HEALDSBURG SENIOR LIVING COMMUNITYFACILITY NUMBER:
496801635
ADMINISTRATOR:DAVIS, DWAYNEFACILITY TYPE:
740
ADDRESS:725 GROVE STREETTELEPHONE:
(707) 433-4877
CITY:HEALDSBURGSTATE: CAZIP CODE:
95448
CAPACITY:82CENSUS: 38DATE:
01/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Cinthya Gamino (Community Relations Director)TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Case Management inspection and met with Cinthya Gamino (Community Relations Director).

The facility has two outbuildings for memory care residents; The facility relocated all residents to the memory care unit #2 and now they are planning on re-opening the memory care unit #1 of the facility by the first week of February and requested CCL to conduct a walk through the unit. During today’s visit staff/LPA toured the facility memory care unit #1 to ensure there are not any concerns about the re-opening of the unit and observed residents’ rooms, kitchen, laundry, medication room that appears to be ready for residents to move in.

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022
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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