<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201291
Report Date: 07/11/2024
Date Signed: 07/11/2024 06:11:03 PM

Document Has Been Signed on 07/11/2024 06:11 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:WOODS RESIDENTIAL FACILITYFACILITY NUMBER:
079201291
ADMINISTRATOR/
DIRECTOR:		WOODS, TEDFACILITY TYPE:
735
ADDRESS:2260 DOVER WAYTELEPHONE:
(925) 439-1247
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 6CENSUS: 2DATE:
07/11/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Rodney Woods, CaregiverTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 7/11/2024 at 2:30pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced pre-licensing/change of ownership inspection. LPA met with Rodney Woods, Caregiver, and explained the purpose of the visit. LPA spoke with Administrator, Ted Woods, via telephone. The facility has an approved fire safety clearance for two (2) non-ambulatory clients and four (4) ambulatory.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage, back yard. The facility has a four (4) bedrooms and two (2) bathrooms. No bodies of water observed. There is sufficient lighting around the facility. Clients rooms are equipped with the proper furniture, bedding, and lighting. Bathrooms showers/tubs were equipped with non skid mats. Locked cabinets available to store medications, toxins and sharps. Hot water temperature is measured at 124.6 degrees Fahrenheit in shared clients' bathroom. There is a minimum of 7-day non-perishables and 2-day perishables foods. Carbon monoxide and smoke detectors present and operable. Facility inspection matches the sketch that was provided.

Facility needs to correct the following by 7/26/2024:
  • Fix stove burner.
  • Clean garage.
  • Remove ladders and tools from backyard.
  • Update and complete client records.
  • Update and complete staff records.

Continued on LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: WOODS RESIDENTIAL FACILITY
FACILITY NUMBER: 079201291
VISIT DATE: 07/11/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC809.
  • Update client's cash resource ledger.

Issues were noted during inspection. LPA observed that facility is not ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Administrator and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2