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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800629
Report Date: 05/05/2023
Date Signed: 05/05/2023 11:57:11 AM

Document Has Been Signed on 05/05/2023 11:57 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
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: 2DATE:
05/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Emilia Beralde, CaregiverTIME COMPLETED:
12:00 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) Jill Nakagawa arrived unannounced to conduct an annual inspection on May 5, 2023, at 9:40 AM. There was once staff member and 2 residents in care at the time of inspection.

LPA conducted a tour with the carestaff. and found the facility to be clean and a comfortable temperature. The residents were socializing and participating in activities in the family room. They also attend Day Program several days each week, now that Covid protocols allow in-person participation.

The bedrooms were furnished as per regulation. The bathroom was clean and had hand soap and paper towels. Other hygiene products were available as needed by residents. The water temperature measured
117 F, which is within regulation of 105-120 F. The kitchen was clean and well-organized and there was ample perishable and non-perishable food available as per Title 22 regulations. Sharps are kept in locked kitchen cabinet and medications are locked in cabinet in dining area.

The backyard was enclosed and had a small garden area with vegetables growing. There was a large fishtank with goldfish for the residents to enjoy watching.

There were 2 fire extinguishers which were last serviced on 09/02/2022 and fully charged. There were 2 carbon monoxide detectors that were tested and operational. The facility has a central fire alarm system.

There were no deficiencies found at the time of inspection. No citations issued.

Exit interview conducted and copy of this report left at facility.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2023
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