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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200612
Report Date: 12/20/2024
Date Signed: 12/20/2024 01:20:42 PM

Document Has Been Signed on 12/20/2024 01:20 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:WOODLAND HOMEFACILITY NUMBER:
079200612
ADMINISTRATOR/
DIRECTOR:		SALDANA, VICKI LFACILITY TYPE:
740
ADDRESS:4219 WOODLAND DRIVETELEPHONE:
(925) 349-5514
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
12/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:33 AM
MET WITH:Alexandria Jackson, Staff SupervisorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 12/20/2024 at 10:00 AM, Licensing Program Analyst (LPA) D. Doidge arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Tatiana Flores, DSP, and explained the purpose of the visit. Lead Staff supervisor, Alexandria Jackson, arrived at 11:41 AM.

LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms 3 of which are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 92 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. First aid kit was observed to be complete. Fire extinguisher was last serviced on 05/14/2024. Fire drill was last conducted on 12/06/2024 and are conducted monthly.

LPA reviewed 3 residents records and 5 staff records all were complete.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
Bennett FongTELEPHONE: (510) 286-4201
David DoidgeTELEPHONE: (916) 475-5913
DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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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