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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000237
Report Date: 03/19/2025
Date Signed: 03/19/2025 05:02:31 PM

Document Has Been Signed on 03/19/2025 05:02 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/
DIRECTOR:
UCLARAY, PATTYFACILITY TYPE:
740
ADDRESS:3388 BELL ROADTELEPHONE:
(530) 889-8122
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 124TOTAL ENROLLED CHILDREN: 0CENSUS: 57DATE:
03/19/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 3/19/2025 LPA Tryon visited the facility to follow up on an incident report dated 3/14/2025. LPA met wtih Destiny Moore. The report stated that a resident had gone outside in the evening to smoke with a friend from outside the facility. The resident came back in a short time later, saying that resident had been attacked by a man and woman outside on the sidewalk, the resident said the strangers had hit and scratched resident.

The facility called the police, who responded, spoke with resident and made a report. Videos from the facility were reviewed and nothing was seen. The cameras do not have a view of the position resident was in at the time. Resident could not describe the strangers. Police said at this point there is really nothing they can do, as they have no way to identify them.

Facility has asked the resident to not go outside and prop the door open to smoke. If resident goes out, the staff will need to be called or doorbell rung to get back in, for the safety of all the other residents.
Resident was offered medical attention and declined.

Resident is doing okay at this time.

It appears the facility reacted appropriately in the situation.

Exit interview conducted.
Troy OrdonezTELEPHONE: (916) 263-4832
Todd TryonTELEPHONE: (916) 263-4700
DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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