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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
496804058
Report Date:
08/29/2022
Date Signed:
08/29/2022 03:13:04 PM
Document Has Been Signed on
08/29/2022 03:13 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:
WINDSONG OF SONOMA
FACILITY NUMBER:
496804058
ADMINISTRATOR:
SAVOIE, DEBORAH
FACILITY TYPE:
740
ADDRESS:
815 WOOD SORREL DRIVE
TELEPHONE:
(707) 776-2885
CITY:
PETALUMA
STATE:
CA
ZIP CODE:
94954
CAPACITY:
95
CENSUS:
72
DATE:
08/29/2022
TYPE OF VISIT:
Post Licensing
UNANNOUNCED
TIME BEGAN:
11:15 AM
MET WITH:
Administrator Deborah Savoie
TIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct a Post-Licensing Inspection and met with Administrator Deborah Savoie. LPA was greeted by staff and asked to screen for COVID. Facility is 2 stories and contains both assisted living and memory care with a current census of 72.
LPA toured building and grounds which were clean and in good repair. Facility was a comfortable temperature and exits were free from obstructions. Staff were observed wearing masks. All staff are boosted. LPA and administrator discussed infection control plan which has been submitted.
Medications are centrally stored and inaccessible to residents in care. Hand sanitizer was available in common areas. Fire extinguishers were last inspected 12/9/2021. LPA observed fire alarm/sprinkler system throughout the facility. Facility has the necessary personal protective equipment (PPE) to support a resident in isolation. All bedrooms are private therefore residents could isolate in their own bedrooms if necessary. Resident bathrooms contain necessary grab bars and non-slip floors/mats.
LPA and administrator discussed Guardian and association process of agency staff.
No deficiencies observed during today's inspection.
Exit interview conducted with Administrator.
SUPERVISOR'S NAME:
Bethany Moellers
TELEPHONE:
(707) 588-5026
LICENSING EVALUATOR NAME:
Shannan Hansen
TELEPHONE:
707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE:
08/29/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/29/2022
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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