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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 451373915
Report Date: 12/17/2024
Date Signed: 12/17/2024 01:18:14 PM

Document Has Been Signed on 12/17/2024 01:18 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WOODCLIFF CARE HOMEFACILITY NUMBER:
451373915
ADMINISTRATOR/
DIRECTOR:		CALLOWAY, JAIMEFACILITY TYPE:
740
ADDRESS:165 WOODCLIFF DRIVETELEPHONE:
(530) 244-2467
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
12/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Administrator, Jaime CallowayTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On December 17, 2024 at approximately 11:00 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Woodcliff Care Home for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Caregiver, Azel Miranda and was granted access into the facility. Administrator arrived 30 minutes later.

LPA and Caregiver toured the facility. LPA observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on December 2024 at the time of the inspection. All smoke detectors sound directly to the fire station. Water temperature in facility bathrooms measured at 108 degrees, within acceptable range of 105 to 120 degrees F. LPA observed sufficient perishable and non-perishable foods located in the kitchen. There are special provisions made for individuals with special dietary needs. Food menu was presently available for viewing during the inspection. Medications were centrally stored and locked. Cleaning products and other toxins are located in the laundry room that was locked and inaccessible to residents in care. There was a supply of linens, cleaners, hygiene products and paper products available for residents. All bathrooms designated for residents in the common areas at the facility were supplied with individual paper towels and hand soap. Bathrooms in resident’s rooms have a towel and soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. A tour of bedrooms were conducted, and bedrooms inspected have lighting and appropriate furnishing. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms of COVID-19 or other infectious diseases are present in the facility. LPA reviewed the infection control plan. LPA was made aware that the facility is currently in the process of updating the Infection Control Plan (See LIC 9102-Technical Violation) First Aid kit was inspected and found to be appropriate during the inspection. Emergency Disaster Drill was last conducted on November 2024.

(Report continued on LIC 809C)
Lauren CrockerTELEPHONE: (916) 202-0832
Farhaan SarangiTELEPHONE: (916) 307-0474
DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WOODCLIFF CARE HOME
FACILITY NUMBER: 451373915
VISIT DATE: 12/17/2024
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LPA reviewed 5 of 5 resident files.1 out of 5 residents did not have a Pre-Placement appraisal. LPA educated the Administrator on the importance of performing, completing and retaining a Pre-Placement Appraisals for residents in care (See LIC 9102-Technical Violation). During a facility file review, LPA observed that no notification in writing was made to the Local Fire Jurisdiction regarding a resident that requires oxygen (See LIC 9102-Technical Violation). LPA educated the Administrator on the importance of ensuring that the Local Fire Jurisdiction is made aware of oxygen being in the facility. LPA reviewed staff files and found those files to be appropriate during the review. LPA provided Technical Assistance regarding how staff and resident files are supposed to be organized, managed and retained in the facility (See LIC 9102-Technical Assistance). LPA requested the following documents to be sent:

LIC 500- Personnel Report
LIC 308- Designation of Facility Responsibility
LIC 309- Administrative Organization
Most up-to-date Liability insurance
Emergency Disaster Plan
Control of Property
Register of residents
Most updated Infection Control Plan

No deficiencies were cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was signed and given to the Administrator.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC809 (FAS) - (06/04)
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