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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570316115
Report Date: 11/15/2024
Date Signed: 11/15/2024 01:51:20 PM

Document Has Been Signed on 11/15/2024 01:51 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:CALIFORNIAN, THEFACILITY NUMBER:
570316115
ADMINISTRATOR/
DIRECTOR:		VALADEZ, FERNANDOFACILITY TYPE:
740
ADDRESS:1224 COTTONWOOD STREETTELEPHONE:
(530) 666-2433
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 130CENSUS: 90DATE:
11/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:34 AM
MET WITH:Fernando Valadez, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:54 PM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced Annual Required – 1 yr. Inspection at The Californian and met with Administrator Fernando Valadez. There were 90 residents present.

LPA arrived at the facility and was greeted by Administrator, Resident Care Coordinator and receptionist. LPA was shown the facility which was found to be clean and at a comfortable temperature with all exits free from obstruction. Clients' bedrooms, common areas, kitchen & food storage areas were inspected. Fire extinguishers were found to be last serviced on 07/20/2024 and fully charged at the time of the visit. A Fire Alarm and Sprinkler System Inspection was completed on 10/24/2024 and the system was found to within acceptable results. A fire drill was conducted for each shift on June 21, 2024. The next drill is scheduled to be held prior to the end of November.

There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator and freezer were properly stored as per regulations on this day at the time of the visit. Toxins and cleaning supplies are locked in storage cabinets. The Generations Grove (memory care unit) has locked cabinets in each room for controlled items. There was a supply of hygiene products and paper products available for clients. All clients' bedrooms have lighting & appropriate furnishings. LPA found the water temperature in 10 out of 10 rooms to be within 105 and 120 F, which is within regulation. Bathrooms were outfitted with grab bars and non-slip mats. The dining rooms were clean and provided adequate seating (AL and Memory Care). The grounds provide plenty of space for outdoor activities. There are shaded walkways and benches, and the front entrance has couches and music playing for residents' enjoyment.

Continued on 809-C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CALIFORNIAN, THE
FACILITY NUMBER: 570316115
VISIT DATE: 11/15/2024
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Continued from 809.....

The Activities Department offers games and other entertainment 7 days a week, and had the facility decorated for the Harvest season. LPA found residents to be engaged in activities throughout the community, including exercise class and a visit from podiatry.

The hospice unit had its own caregiver, along with a resident therapy pet, which the residents found very endearing and comforting.

LPA reviewed 5 resident files and 5 personnel files and found them to be complete.

There were no deficiencies found at the time of inspection.

No citations were issued.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
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