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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366403722
Report Date: 11/20/2023
Date Signed: 11/20/2023 03:32:07 PM


Document Has Been Signed on 11/20/2023 03:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:WOODS RESIDENTIALFACILITY NUMBER:
366403722
ADMINISTRATOR:CHRISTINE WOODSFACILITY TYPE:
735
ADDRESS:1172 EAST TWENTY-SIXTH STREETTELEPHONE:
(909) 882-3995
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY:6CENSUS: 6DATE:
11/20/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Veronica VasquezTIME COMPLETED:
03:34 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Anna Bueno and Bianca Wolcott made an unannounced visit at the facility for the purpose of conducted a Plan of Correction (POC) visit. LPAs met with staff Veronica Vasquez who was informed of the purpose of the visit. Vasquez phoned licensee Christine Woods who spoke with LPA Bueno.

On 10/26/2023 the facility was issued two deficiencies with a plan of correction date of 11/17/2023. LPAs inspected client bedrooms and found no evidence of live bugs. Client and staff interviews reveal that the facility have no recent reports of bed bugs. LPAs found adequate food supply for at 2 days of perishable and 7 days of non perishable items. Interviews with staff reveal a facility menu however it was not viewable during LPAs visit. The facility will receive a Letter of Deficiency Citation Cleared for these deficiency.

An exit interview was conducted where a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2023
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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