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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 576804118
Report Date: 12/15/2023
Date Signed: 12/15/2023 04:29:44 PM


Document Has Been Signed on 12/15/2023 04:29 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: 2DATE:
12/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:April Walford, AdministratorTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted a Required One Year inspection at Walford Residential Care on December 15, 2023. LPA met with April Walford, Administrator/Licensee. The facility currently has two 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 and resident records are stored and locked in closet in hallway. LPA inspected two out of two resident records and found them to be complete. LPA inspected four staff files and found them complete. Carbon monoxide detector and smoke detectors were tested and functional. There was one fire extinguisher in kitchen/dining area that was fully charged and last serviced on August 30, 2023. Disaster Drill was conducted on November 1, 2023 for staff of all three shifts. The kitchen was clean and sanitary. There was an ample supply of perishable and non-perishable foods, as required per Title 22. Sharps were locked and inaccessible to residents. The two bathrooms were clean, sanitary and outfitted with soap and paper towels. There are non-skid mats in the shower/bath. The backyard was clean and free of debris. There were tables and chairs and umbrellas for outdoor seating and visitation. There is also a gardening area for residents to enjoy. The facility is adding a storage/staff area in the current garage, which has been permitted.

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: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2023
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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