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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804058
Report Date: 03/24/2023
Date Signed: 03/24/2023 11:54:16 AM


Document Has Been Signed on 03/24/2023 11:54 AM - 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:WINDSONG OF SONOMAFACILITY NUMBER:
496804058
ADMINISTRATOR:SAVOIE, DEBORAHFACILITY TYPE:
740
ADDRESS:815 WOOD SORREL DRIVETELEPHONE:
(707) 776-2885
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY:95CENSUS: DATE:
03/24/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Regional Vice President of Operations for Integral Senior Living, Roselynn Muzzy, Nurse Support of Allen Flores group, Lori Asay, RCD Aaron Lawman, and Administrator Deborah Savoie.TIME COMPLETED:
11:53 AM
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An informal meeting was conducted today via Microsoft Teams, present in the meeting were, Licensing Program Manager, Bethany Moellers, Licensing Program Analyst, Shannan Hansen, Regional Vice President of Operations for Integral Senior Living, Roselynn Muzzy, Nurse Support of Allen Flores group, Lori Asay, RCD, Aaron Lawman, and Administrator Deborah Savoie.

The purpose of the informal office meeting was to discuss concerns that have been identified by the department. Licenses was issued on 08/01/2022 and since six complaints have been investigated and four repeat civil penalties have been issued.

The following was discussed during the office meeting:

* Reporting Requirements

* Medication documentation (MARS)

* Staff Training

* Sufficient Staff

* Associated Staff


Participants in this meeting have been informed that the informal meeting is part of the departments administrative process, further non compliance may result in a non compliance plan.

No citations issued
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
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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