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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 576804118
Report Date: 12/10/2024
Date Signed: 12/10/2024 03:46:26 PM

Document Has Been Signed on 12/10/2024 03:46 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:WALFORD RESIDENTIAL CAREFACILITY NUMBER:
576804118
ADMINISTRATOR/
DIRECTOR:
WALFORD, APRILFACILITY TYPE:
740
ADDRESS:616 LEWIS AVETELEPHONE:
(530) 665-6004
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 6CENSUS: 3DATE:
12/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:April Walford, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted a Required One Year inspection at Walford Residential Care on December 10, 2024. LPA met with April Walford, Administrator/Licensee. The facility currently has three residents in care.

Licensee conducted a walk through and LPA observed bedrooms have lighting & appropriate furnishings. LPA observed all walkways and exits to be unobstructed. Toxins are locked and stored in locker in garage. Medications and resident records are stored and locked in office in hallway. LPA inspected 2 of 3 resident records and found them to be complete. The third resident had just arrived and paperwork was being completed. LPA inspected four of four staff files and found them complete. Carbon monoxide detector and smoke detectors were tested and functional. There was one fire extinguisher in kitchen/dining area that was fully charged and last serviced on 08/27/2024. Disaster Drill was conducted on 11/18/2024 for staff of all three shifts. The kitchen was clean and sanitary. There was an ample supply of perishable and non-perishable foods, as required per Title 22. Sharps were locked and inaccessible to residents. The two bathrooms were clean, sanitary and outfitted with soap and paper towels. Water temperature measured between 109-113 degrees F. There are non-skid mats in the shower/bath. The backyard was clean and free of debris. There were tables and chairs and umbrellas for outdoor seating and visitation. There is also a gardening area for residents to enjoy; onions and sweet potatoes are currently in the ground.

The facility has a staff quarters, which is secured and separate from resident living area.

No deficiencies found at the time of inspection.
No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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