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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201291
Report Date: 08/06/2024
Date Signed: 08/06/2024 02:57:44 PM

Document Has Been Signed on 08/06/2024 02:57 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: 1DATE:
08/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Rodney Woods, CaregiverTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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On 8/6/2024 at 2:15pm, Licensing Program Analyst (LPA) L. Hall conducted an announced continuation pre-licensing inspection. LPA met with Rodney Woods, Caregiver, and explained the purpose of the visit. LPA spoke with Administrator/Licensee, 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. LPA observed all corrections were completed.

LPA presented Component III power point during visit and discussed the regulations embodied in the power point. LPA observed the participant gained knowledge about running and maintaining the facility in accordance with regulations.

No Issues were noted during inspection. LPA observed that facility is 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: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2024
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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