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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801578
Report Date: 08/25/2022
Date Signed: 08/30/2022 10:05:27 AM


Document Has Been Signed on 08/30/2022 10:05 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 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:
08/25/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:19 PM
MET WITH:Jully CartelTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) A. Canela arrived at this facility for the purpose of conducting a closure inspection pursuant to voluntary closure of this licensed Residential Care Facility for the Elderly. LPA arrived and was allowed in the facility by Licensee, Jully Cartel.

LPA inspected all rooms and the exterior of the building today and found no evidence that would suggest that any residents are residing on the premises. All clothing and personal items belonging to residents have also been removed.

The Licensee initiated this facility closure and submitted a signed written statement to Community Care Licensing (CCL) on August 23, 2022, requesting to close this facility. The facility has had no residents in the last three months and did not have to issue any evictions or notify any resident's or family.

Closure inspection of this facility has been completed. LPA will finalize review of facility records and submit for Closure. Licensee surrendered their facility license to LPA Canela during todays final inspection.

No deficiencies cited during today's visit.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2022
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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