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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804150
Report Date: 10/23/2025
Date Signed: 10/23/2025 01:56:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2025 and conducted by Evaluator Shannan Hansen
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20251022162850
FACILITY NAME:WINDSONG OF SONOMAFACILITY NUMBER:
496804150
ADMINISTRATOR:JOHN BELTZFACILITY TYPE:
740
ADDRESS:815 WOOD SORREL DRIVETELEPHONE:
(707) 776-2885
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY:95CENSUS: 79DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:John Beltz, AdministratorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility has rodents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hansen arrived unannounced to open a complaint investgation and delivered complaint findings. LPA met with Administrator, John Beltz.

During investigation LPA made observations, conducted interviews and obtained documents.

Facility has rodents- Reporting party alleges for the last couple of months rat droppings have been under drink machines /cup holders in the kitchen and dining room. Based on documents obtained and interviews with staff it was revealed the first presence of rodents was January 2025. In July, rodent problem escalated to needing a different pest control company, that to date has serviced approximately 6 times so far, not resolving the problem. During today’s (10/23/2025) visit, LPA observed a large rodent bait station next to ice cream freezer ......
Continue on LIC9099C



Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 21-AS-20251022162850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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: 496804150
VISIT DATE: 10/23/2025
NARRATIVE
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Continued from LIC9099

& under filtered water station with rodent glue/sticky traps in a few other places in kitchen (see photos). LPA further observed rodent feces on the floor behind the stove where rodents have pulled insulation out and under/behind lower cup trays in kitchen. LPA also observed rodent droppings on service tray containing clean table linens in kitchen (see pics).


Based on LPA's observations, interviews conducted, and records reviewed/obtained, the preponderance of evidence standard has been met, therefore the above allegation facility has rodents is found to be SUBSTANTIATED.

The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 21-AS-20251022162850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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: 496804150
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2025
Section Cited
CCR
87555(b)(27)
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87555 General Food Service Requirements
(b) The following food service requirements shall apply:
(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.

This requirement is not met as evidenced by:
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ED/Administrator agrees to submit thourough plan of how to eliminate the rodent infestation by POC due date of 10/24/2025.
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Based on observation and interviews, the licensee did not comply with the section cited above in that rodents, rodent feces and rodent traps were observed in the kitchen and dining areas which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
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