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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700594
Report Date: 06/21/2021
Date Signed: 06/21/2021 11:15:17 AM

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: 51DATE:
06/21/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:ADMINISTRATOR - MICHELLE SWEARINGENTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Ruth Wallace made an unannounced visit on this day for the purpose of conducting a case management visit - other. LPA spoke to Administrator (AD) regarding the nature of the visit to review staff 1 (S1’s) file for fingerprint clearance.

Administrator had called LPA to enquire why S1 was not showing up on their LIS Personnel Summary. AD also stated that S1 is fingerprint cleared and in the Guardian system. There appears to be a issue trying to get him associated in the Guardian system. LPA will have support staff get this issue resolved. LPA reviewed staff file for Staff 1 (S1). S1 did have a fingerprint clearance and is seventeen years old working in the kitchen as a server.

No deficiencies cited on today's visit.

An exit interview was conducted with and a copy of this report along with confidential names list was provided.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021
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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