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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006186
Report Date: 08/22/2024
Date Signed: 08/22/2024 10:36:23 AM

Document Has Been Signed on 08/22/2024 10:36 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:WOODBRIDGE CARE HOME, INC.FACILITY NUMBER:
306006186
ADMINISTRATOR/
DIRECTOR:
ALPUERTO, TERESAFACILITY TYPE:
740
ADDRESS:18932 GREEN WILLOW COURTTELEPHONE:
(714) 505-9209
CITY:NORTH TUSTINSTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 5DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:13 AM
MET WITH:Anna Mallari - AdministratorTIME VISIT/
INSPECTION COMPLETED:
10:51 AM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility unannounced for the purpose of conducting a required annual inspection. LPA was greeted at the facility by Luisa Cruz, House Manager/DSP. LPA met with Administrator Anna Mallari and explained the purpose of the inspection.

The facility is a one-story home with five resident bedrooms, three resident bathrooms, kitchen, dining room, living room, laundry room, atrium, caregiver room, backyard and attached two-car garage. Facility appears clean, safe and sanitary. LPA observed the facility has the necessary postings posted on the walls. LPA noted two residents were lounging in the living room and their own bedroom. Other residents were noted as being away at day program.

All resident rooms had the required elements, including bed, chair, closet space and ample lighting. Facility has extra linens and hygiene supplies for residents in the hallway closets. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water measured between 105 and 120 degrees F. LPA observed facility has emergency food and water supply as well as additional emergency supplies. LPA observed the fire extinguisher was last serviced on May 13, 2024. LPA observed smoke/carbon monoxide detectors to be operational. LPA observed hazardous items such as knives, chemicals and cleaners to be locked up in the kitchen and a closet in the laundry room. Knives are locked up separate from toxic chemicals. Medication for each resident is kept locked in a cabinet in the dining room. Exit gate was observed to be unlocked. LPA observed exit gate to be unobstructed. LPA reviewed three resident files and three staff files. LPA also reviewed medication for three residents. LPA interviewed one staff and one resident.

Based on today's inspection, no deficiencies are being issued. An exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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