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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 576804194
Report Date: 04/23/2024
Date Signed: 04/23/2024 04:33:45 PM


Document Has Been Signed on 04/23/2024 04:33 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:GODFREY, ROBERTFACILITY TYPE:
740
ADDRESS:240 PALM AVETELEPHONE:
(530) 661-0574
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:100CENSUS: 64DATE:
04/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Robert Godfrey, AdministratorTIME COMPLETED:
04:02 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived to conduct an unannounced inspection and check on the program plan. LPA met with Lauren Andersen, Director and Robert Godfrey, Administrator. There were 64 residents 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, dining room, and activities 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.

The facility was recently painted inside and out and new floors installed. The outdoor courtyard was free of debris, flowers planted and plenty of covered seating for residents and guests provided.

Residents were observed in the dining room, socializing and enjoying their meal on cloth-covered tables.

There were 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: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2024
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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