<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800629
Report Date: 04/29/2022
Date Signed: 04/29/2022 12:05:34 PM

Document Has Been Signed on 04/29/2022 12:05 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:WOODRIDGE HOMEFACILITY NUMBER:
486800629
ADMINISTRATOR:ELAINE GOFACILITY TYPE:
735
ADDRESS:184 WOODRIDGE CIRCLETELEPHONE:
(707) 447-5572
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 6CENSUS: 4DATE:
04/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:23 AM
MET WITH:Staff, Lucina BrindasTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Walters arrived unannounced to conduct a Required 1-year annual inspection and was greeted by Staff, Lucina Brindas. The licensee, Bella Corpus arrived later.

There was a sign posted at the entrance of the facility that stated that the facility is not currently accepting visitors. Once allowed in the facility, LPA was not screened for COVID symptoms, or signed in. LPA and Licensee, Bella Corpus discussed the updated visitation PIN 22-07, that provides guidance on indoor visitation. BC agreed to remove the no-visitors sign. BC will update visitors policy and explain their screening process in detail on mitigation plan and send LPA a copy 6/30/22.

Neither staff were wearing mask. LPA discussed the importance of wearing mask with Licensee. Signs were posted throughout the facility to promote social distancing and droplet precaution. The facility was clean and comfortable temperature. The facility is disinfected twice daily and as needed. Sinks were stocked with hand washing supplies and paper towel. Facility has at least a 30 day supply of Personal Protective Equipment (PPE). Licensee has not yet had staff fit-tested for N-95 mask. LPA is requesting that Licensee provides proof of fit testing by 5/20/22. LPA reviewed activities that have been developed for clients in care. LPA and BC also discussed developing additional planned activities to engage clients.

The facility previously submitted a mitigation plan that was approved by Community Care Licensing, but since then there have been updated regulatory requirements related to infection control prevention and mitigation for communicable diseases. LPA is requesting that the facility submits an updated mitigation plan by 6/30/22. LPA provided a copy of new requirements in PIN 22-13 ASC and PIN 22-07. There were (3) technical assistance notes provided to Licensee during this inspection. Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1