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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 576804194
Report Date: 07/22/2024
Date Signed: 07/22/2024 04:49:57 PM


Document Has Been Signed on 07/22/2024 04:49 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:WOODLAND GARDENS SENIOR LIVINGFACILITY NUMBER:
576804194
ADMINISTRATOR:LAUREN ANDERSENFACILITY TYPE:
740
ADDRESS:240 PALM AVETELEPHONE:
(530) 661-0574
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:100CENSUS: 64DATE:
07/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Lauren Andersen, AdministratorTIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Inspection on 07/22/2024. LPA met with Lauren Andersen, Administrator. There are currently 64 residents in the facility.

The facility operates as an RCFE providing assisted living and memory care. The facility is one level, with resident rooms, an activities room, living room, dining room, kitchen, medication room, laundry room with storage room, and a memory care unit with dining/activities room and resident bedrooms. There are secure outside areas for residents to enjoy, as well.

A locked storage for toxins and cleaning supplies is provided in the kitchen separate from food storage. There are also secured storage areas in hallways, housekeeping closet and in storage building. All exits were unobstructed. There was a First Aid Kit, night lights and flashlights for emergency lighting, an ample supply of linens, paper products and hygiene supplies. Bathrooms were equipped with grab bars and non-slip mats. Fire Extinguishers were fully charged and serviced on 01/24/2023. The last Fire Drill was on 6/25/2024 and staff receive training regarding emergency situations each month at employee/staff meetings. The dining room and kitchen area were clean and sanitary. The facility had an ample supply of perishable and nonperishable food as required by Title 22. There is an active Activities Program with multiple participants taking part in many calendered events including Wii -Bowling, Bingo, crafts, and other favorites chosen by the Resident Council.

LPA found no deficiencies during this inspection. No citations issued.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024
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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