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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005443
Report Date: 08/20/2021
Date Signed: 08/20/2021 12:11:15 PM

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:WINDING WAY VILLA, LLC.FACILITY NUMBER:
347005443
ADMINISTRATOR:STROUP, JENNIFERFACILITY TYPE:
740
ADDRESS:4316 ILLINOIS AVENUETELEPHONE:
(916) 671-3278
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 5DATE:
08/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Laura Barney TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Melana Llopis arrived at the facility unannounced on 08/20/2021 to conduct a Required - 1 Year inspection. LPA met with Administrator, Laura Barney and explained the purpose of the visit. Prior to visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; upon entry LPA completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by Amber Ammann, staff, upon entering the facility.

LPA and Administrator toured the facility together. Areas inspected include but are not limited to the following:
Kitchen, living room, dinning area, resident bedrooms and bathrooms, laundry room and backyard. LPA found the facility to be odor-free and in good repair. LPA observed sharps and toxins to be locked and inaccessible to residents in care. LPA observed an adequate supply of 7 day non-perishable food items and 2 day perishable food items. LPA observed resident bedrooms to have sufficient lighting and required furniture. LPA measured the water temperature to be 102 degrees F. LPA observed resident bathrooms to have required grab bars and nonskid mats. LPA found the fire extinguisher to be last serviced on 08/12/2021 and fully charged. LPA found first aid kit to be complete.
LPA reviewed infection control procedures with Administrator and found facility to be in compliance.

LPA reviewed two (2) of two (2) residents' files in care and found records to be current and complete.
LPA reviewed staff (S1) and the Administrator's file and were found to be current and complete.
LPA reviewed resident, R1's hospice care plan and was found to be complete.

LPA conducted a medication audit for one (1) resident in care and found no errors.
No deficiencies are being cited as a result of today's visit.
Exit interview conducted, copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
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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