312700259-2-20-2025-59-AS-CMIN-DE3RSX-20250220121728

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 312700259
Report Date: 02/20/2025
Date Signed: 02/20/2025 12:17:46 PM

Document Has Been Signed on 02/20/2025 12:17 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	WOODCREEK VILLA LLC		FACILITY NUMBER:	312700259
ADMINISTRATOR/ DIRECTOR:	GARCIA, STEPHANIE		FACILITY TYPE:	740
ADDRESS:	521 COULSTON COURT		TELEPHONE:	(916) 540-0914
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	02/20/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:05 AM
MET WITH:	Stephanie Garcia, Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:25 PM

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Licensing Program Analyst (LPA) Cassandra Mikkelson arrived unannounced and met with Administrator Stephanie Garcia to conduct an annual inspection utilizing the inspection tool.

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed six (6) resident rooms, two (2) common area bathrooms, kitchen, common areas and exterior of facility. LPA observed rooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 120.0 degrees F.

LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two day perishable and (7) seven day non-perishable food supply on hand. Smoke detectors and carbon monoxide detectors are operational in the care home. Fire extinguishers and first aid kit are maintained and ready for emergency use. LPA checked medication storage and found medications to be locked away and inaccessible to the residents. LPA reviewed five (5) resident files, two (2) staff files and two (2) resident medications.

Facility has a current copy of certificate of liability insurance and LPA obtained a copy.

As a result of this visit, no deficiencies were cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview was conducted with Administrator.

Laura Munoz	TELEPHONE: (916) 709-6317
Cassandra Mikkelson	TELEPHONE: (916) 709-6830
	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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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