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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000237
Report Date: 02/15/2024
Date Signed: 02/15/2024 03:39:11 PM


Document Has Been Signed on 02/15/2024 03:39 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:OAKWOOD VILLAGE, INC.FACILITY NUMBER:
317000237
ADMINISTRATOR:CATHY DUSTINFACILITY TYPE:
740
ADDRESS:3388 BELL ROADTELEPHONE:
(530) 889-8122
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:124CENSUS: 44DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cathy Dustin, Patty UclarayTIME COMPLETED:
04:00 PM
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On 2/15/2024 LPA Tryon visited the facility to conduct an annual visit. LPA met with Director Cathy Dustin and Administrator Trainee Patty Uclaray. The facility currently has 44 residents.

LPA toured the facility with Ms. Uclaray including common areas, resident rooms, bathrooms, kitchen, dining area, food storage, hallways, medication rooms, storage for potentially hazardous items and materials. The facility is clean and well-furnished, resident rooms were clean and had appropriate furnishings. Food supplies appeared to be well-stocked to meet the requirement of 2 days perishable and 7 days non-perishable. Food was stored appropriately to maintain freshness. Lunch appeared appealing and appetizing.

Medications are centrally stored and locked. Facility keeps centrally stored logs. Controlled substances are double-locked in the medication carts. Chemical storage was viewed, cleaning chemicals are stored in a locked metal cabinet

Hot water is within appropriate temperature range. The building has a fire alarm/sprinkler system that is checked regularly. Fire extinguishers present and charged.

LPA reviewed the CARE Tool with Administrators. LPA interviewed 3 staff and 2 residents, reviewed 4 resident charts and 5 staff charts.

LPA requested copies of current liability insurance proof, administrator certificates.

At this time the facility appears to be in substantial compliance with the regulations. No deficiencies cited.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
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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