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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 572700610
Report Date: 09/05/2023
Date Signed: 09/05/2023 10:54:29 AM

Document Has Been Signed on 09/05/2023 10:54 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:WOODLAND COMMUNITY OPTIONSFACILITY NUMBER:
572700610
ADMINISTRATOR:PEFLEY, SHELLYFACILITY TYPE:
775
ADDRESS:45 W COURT STREETTELEPHONE:
(916) 283-8302
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 50CENSUS: 33DATE:
09/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Judy Arrezola, Program SupervisorTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an unannounced inspection and check on the program plan. LPA met with Judy Arrezola, Program Supervisor. There were 33 residents and 14 staff at the time of inspection.

The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. The common areas, kitchen, laundry, isolation room, 4 bathrooms and art room were inspected. Toxins are stored in a locked cabinet inside the laundry room. Dangerous items were stored inaccessible to clients. There was a supply of cleaners, hygiene products and paper products available for clients.

There were two (2) new clients attending the program and they seemed to be enjoying the new experience. Staff was very supportive and everyone was very welcoming. Clients have already started on preparing for Halloween with the crafting of a Haunted House.

There were no deficiencies found at the time of inspection. No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2023
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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