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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700427
Report Date: 12/13/2021
Date Signed: 12/14/2021 09:06:51 AM

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:WOODVIEW CARE HOMEFACILITY NUMBER:
342700427
ADMINISTRATOR:NEGRU, INGRID DIANAFACILITY TYPE:
740
ADDRESS:120 WOODVIEW DRTELEPHONE:
(773) 318-3588
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:6CENSUS: 4DATE:
12/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:TIME COMPLETED:
04:30 PM
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On 12/13/2021 LPA Tryon visited the facility to perform an Annual Inspection using the Infection Control Domain of the Annual Tool.

Prior to visiting, LPA had contacted the facility and did a quick screen to learn that there are no COVID positive residents or staff at this time. LPA screened prior to entering including taking temperature and using hand sanitizer.
LPA requested a copy of most recent Administrator Certificate, copy of liability insurance, and current staff schedule.

A Technical Advisory was issued regarding N-95 Fit Testing. The facility is in the process of finding a resource.

LPA did a walk-through of the house with the Admionistrator, viewing common areas, kitchen, bedrooms, bathrooms, yard, storage, etc. Food supplies appear adquate to meet the requirement of 2 days perishable and 7 days non-perishable supplies The facility appears to be clean and in good repair. Smoke detectors and carbon monoxide detectors are installed and functioning. The facility appears to be in substantial 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: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
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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