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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530241
Report Date: 02/21/2025
Date Signed: 02/21/2025 09:25:23 AM

Document Has Been Signed on 02/21/2025 09:25 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:WILDWOOD COURT LLCFACILITY NUMBER:
365530241
ADMINISTRATOR/
DIRECTOR:		WILLIS, TANYAFACILITY TYPE:
740
ADDRESS:11898 LUNA ROADTELEPHONE:
(951) 764-4633
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 6CENSUS: 5DATE:
02/21/2025
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Tanya Willis- AdministratorTIME VISIT/
INSPECTION COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) Michelle Echeverria conducted an announced visit to the facility for the purpose of a room conversion. LPA was greeted and granted entrance by the Licensees, Tanya Willis and Jahmaal Willis.

Per the LIC200, the licensees requested for the capacity to remain the same (5) nonambulatory and (1) bedridden on 11/25/2024. The fire clearance request was approved on 02/19/2025 for (5) nonambulatory and (1) bedridden. Bedrooms #1,#2, and #3 are private bedrooms and occupy (1) nonambulatory resident per room. Bedroom #4 is a private (1) bedridden bedroom. Bedroom #5 is a semiprivate bedroom which occupies (2) nonambulatory residents.

There is a facility sketch on file with designation of capacity for each room. The licensees were advised that the noted designated capacity for each room is to remain in compliance.

LPA observed that the resident bedrooms were appropriately furnished and had functional lighting. The physical plant is ready for an updated license. LPA will update the facility's file and issue a new license stating the change in bedrooms.

There are (5) residents in care who are in their bedrooms.

An exit interview was conducted where this report LIC809 was discussed and provided to the Licensees, Tanya Willis and Jahmaal Willis.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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