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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700594
Report Date: 06/03/2020
Date Signed: 06/03/2020 05:04:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:WOODLAKE, THEFACILITY NUMBER:
342700594
ADMINISTRATOR:SWEARINGEN, MICHELLEFACILITY TYPE:
740
ADDRESS:1445 EXPO PARKWAYTELEPHONE:
(916) 604-3780
CITY:SACRAMENTOSTATE: CAZIP CODE:
95815
CAPACITY:144CENSUS: 0DATE:
06/03/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Michelle Swearingen, Executive DirectorTIME COMPLETED:
12:30 PM
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On June 3, 2020, at 10am, Licensing Program Analyst, (LPA) De Anna Williams-Lyons, conducted a tele visit with Michelle Swearingen, Executive Director, who assisted in conducting this Pre-licensing inspection. The facility has 3 floors and a capacity of 144 residents. The facilities Administrator’s Certificate, Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing. The room temperature was 72 degrees F which is within range.

LPA inspected the interior and the exterior of the facility including the common living spaces, resident's bedrooms and bathrooms, kitchen and dining room. In the kitchen area, Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. LPA observed fire extinguisher and first aid kit to be complete and ready for emergency use. Hot water temperatures was not taken, but will be in the future. There’s appropriate lighting throughout the facility.
Dining room, and areas designated for resident use were toured. Furniture and furnishings were observed to be sufficient and in good repair. Resident's bedrooms and bathrooms were toured. Bedrooms had all the required items of furniture. Window screens appeared to be in good repair. Bathrooms were clean and sanitary and consisted of grab bars and non-skid mats. The sink, toilet, and shower operate properly.

First aid kit was present and included the required scissors, tweezers, thermometer and guide. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguishers are maintained and ready for emergency use. Stairways, inclines, open porches and areas of potential hazards accessible to residents, are equipped with sturdy hand railings.

To continue see 812-C...
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: WOODLAKE, THE
FACILITY NUMBER: 342700594
VISIT DATE: 06/03/2020
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LPA inspected the exterior grounds of this facility. There are no bodies of water on the premises. Indoor and outdoor passageways are free of obstruction and potential hazards. There are no medications in the facility because the facility has no residents at this time. There are currently no staff or clients files available for review.

During this visit, the facility is in compliance and meets the minimum requirements for a RCFE license.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed during this visit.

Licensee unable to sign. LPA will send a copy of report for Executive Director Michelle Swearingen to sign. Executive Director to send a signed copy back to CCL.


Application is pending further review.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2