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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000237
Report Date: 02/23/2022
Date Signed: 02/24/2022 08:55:57 AM


Document Has Been Signed on 02/24/2022 08:55 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:OAKWOOD VILLAGE, INC.FACILITY NUMBER:
317000237
ADMINISTRATOR:AREND VERWEIJFACILITY TYPE:
740
ADDRESS:3388 BELL ROADTELEPHONE:
(530) 889-8122
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:124CENSUS: 60DATE:
02/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Arend VerweijTIME COMPLETED:
01:30 PM
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LPA Tryon arrived at the facility on 2/23/22 to perform an annual visit using the Infection Control Domain. Prior to the visit, LPA did a self-screening by taking temperature and reviewing symptoms. LPA wore an N-95 mask and washed my hands prior to entering the building. LPA met with Administrator Arend Verweij.

LPA toured the facility including common areas, dining room, resident bedrooms, bathrooms, hallways, , yard.

LPA reviewed the infection control domain with the Administrator. .

The facility has trained a couple of staff to performed FIT testing for staff.

The facility appears to be insubstantial compliance at this time.

Exit interview conducted
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2022
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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