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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701131
Report Date: 03/25/2024
Date Signed: 04/02/2024 05:42:55 PM

Document Has Been Signed on 04/02/2024 05:42 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WOODS BOARD AND CARE LLCFACILITY NUMBER:
502701131
ADMINISTRATOR:WOODS, RANDYFACILITY TYPE:
735
ADDRESS:2642 TOPEKA STREETTELEPHONE:
(209) 869-6624
CITY:RIVERBANKSTATE: CAZIP CODE:
95367
CAPACITY: 15CENSUS: 14DATE:
03/25/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jessica RuizTIME COMPLETED:
04:00 PM
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Unannounced Plan of Correction visit made out to this facility on 03/25/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Jessica Ruiz. A brief interview was conducted with the facility designated Administrator at this time.
Current census was 14 residents.
The purpose of this visit was to follow up on the deficiencies that were cited from a prior visit conducted on 03/15/2024 and to follow up on the Plan of Correction. The following deficiencies were observed and cited on 03/15/2024:
  • The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) Tuberculosis test documents as specified in Section 80065(g).

This facility did complete the Plan of Correction and provided all of the required forms and documents at this time.

Plan of Correction clearance letters were printed and copies were provided to the facility designated Administrator at this time.

There were no further deficiencies observed or cited during today's Plan of Correction visit.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2024
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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