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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700259
Report Date: 02/22/2023
Date Signed: 02/22/2023 11:02:19 AM


Document Has Been Signed on 02/22/2023 11:02 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:WOODCREEK VILLA LLCFACILITY NUMBER:
312700259
ADMINISTRATOR:GARCIA, STEPHANIEFACILITY TYPE:
740
ADDRESS:521 COULSTON COURTTELEPHONE:
(916) 540-0914
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: 5DATE:
02/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Maylyn Bradford, House ManagerTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. Annual inspection for facility was completed on 2/7/23 but report was generated under a different facility. LPA returned to generate report under Woodcreek Villa LLC. LPA met with House manager Maylyn Bradford during today's inspection. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks.

LPA toured facility with administrator to ensure health and safety of residents in care. LPA toured resident rooms, bathrooms, kitchen, common living spaces, outdoor space, and staff area. In the areas toured no immediate health, safety, or personal rights violations were observed. Administrator stated there has been no COVID cases at the facility, and facility has sufficient amount of PPE. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA and Administrator completed the infection control domain on 2/7/23 and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023
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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