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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804011
Report Date: 04/02/2024
Date Signed: 04/02/2024 01:04:23 PM

Document Has Been Signed on 04/02/2024 01:04 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:WINDSOR GOLDEN LIVINGFACILITY NUMBER:
496804011
ADMINISTRATOR:ALCONES, ARTHUR O.FACILITY TYPE:
740
ADDRESS:65 BLUEBIRD DRIVETELEPHONE:
(707) 953-2161
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 6CENSUS: 5DATE:
04/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Arthur Alcones (Licensee)TIME COMPLETED:
01:19 PM
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Licensing Program Analyst (LPA) Cuadra conducted an unannounced Case Management visit to this facility and met with Licensee, Arthur Alcones who on February 26, 2024 notified the Department of the installation of fire sprinklers in the facility to have them available in case of emergencies. At that date, the estimated completion date was projected by the end of the week or March 1, 2024. The licensee submitted a written plan ensuring the health, safety and personal rights of all residents in care during the construction. On March 20, 2024 Licensee submitted proof of completion and passed the inspection conducted by Fire Marshal of the town of Windsor.

During today's visit, LPA observed posted signs for "Caution Under Construction DO NOT ENTER" by the left side of the facility's backyard, there was no construction crew members present, but there was some debris. Per Licensee, the plumbers are taking some time to get the trenching and plumbing work done due to the weather conditions. No materials and equipment were observed. LPA observed auditory alarms located around the facility and they were operational. Staff is also required to continuously remind and check all residents to make sure that they are not going to the construction area. All resident's responsible parties were notified.

Licensee told LPA that they have additional construction plans to convert the garage into more rooms for them to be able to increase their capacity. However, they are in the process of obtaining a building permit from the town of Windsor to start with the construction. LPA/Licensee discussed the importance of resident's safety throughout the construction project. Licensee assured LPA that the construction staff and facility staff will make sure that safety precautions regarding tools, toxins and exposure to safety hazards will addressed daily and while construction crews are on site and after the daily construction work is completed. Licensee agreed that a written plan needs to be submitted to CCL prior to start the expected construction. Licensee also agrees to submit proof of contact with Fire Marshall regarding space modifications to ensure Fire Code Compliance.
No deficiencies cited during today's inspection. Exit interview conducted with Licensee and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2024
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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