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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 576804118
Report Date: 04/21/2023
Date Signed: 04/21/2023 03:00:13 PM


Document Has Been Signed on 04/21/2023 03:00 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:WALFORD RESIDENTIAL CAREFACILITY NUMBER:
576804118
ADMINISTRATOR:WALFORD, APRILFACILITY TYPE:
740
ADDRESS:616 LEWIS AVETELEPHONE:
(530) 665-6004
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:6CENSUS: 0DATE:
04/21/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:April Walford, Administrator/LicenseeTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted a Post Licensing inspection at Walford Residential Care. LPA met with April Walford, Administrator/Licensee. Currently, the facility does not have any clients in care.

Licensee conducted a walk through and LPA observed bedrooms have lighting & appropriate furnishings. LPA observed all walkways and exits to be unobstructed. Toxins are locked and stored in locker in garage. Medications will also be locked and stored in cupboard in kitchen/dining area. Licensee will ensure client medication is documented properly on a Centrally Stored Medication Log. Licensee will ensure staff and client records will be complete and maintained once they receive their first admission. Licensee will ensure staff annual training is maintained and Disaster Drills are conducted every 3 months. Licensee will ensure there are extra linens for when they receive admissions to the facility. Fire extinguisher was new and fully charged, receipt attached.


No deficiencies found at the time of inspection.
No citations issued.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
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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