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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801578
Report Date: 05/18/2022
Date Signed: 08/25/2022 01:33:30 PM


Document Has Been Signed on 08/25/2022 01:33 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 RESIDENTIAL CARE IIFACILITY NUMBER:
486801578
ADMINISTRATOR:CARTEL, JULLYFACILITY TYPE:
740
ADDRESS:738 OAKWOOD AVE.TELEPHONE:
(707) 557-5939
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:6CENSUS: 0DATE:
05/18/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Jully CartelTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA), Araceli Canela arrived at Woodridge Residential Care for the purpose of conducting a Plan of Correction (POC) inspection. LPA had attempted an earlier visit but no one was home. LPA called administrator who came over to the facility and explained they recently relocated the only resident they had in the facility.


Facility completed a self certification to clear deficiences

LPA also came to obtain signature on a previous visit, where computer locked and LPA was unable to gather the signature.

No deficiencies were observed during today's Plan of Correction (POC) inspection. Exit interview was conducted and a copy of this report was printed and given to the Licensee.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022
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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