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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 576804194
Report Date: 12/12/2024
Date Signed: 12/12/2024 11:00:23 AM

Document Has Been Signed on 12/12/2024 11:00 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:WOODLAND GARDENS SENIOR LIVINGFACILITY NUMBER:
576804194
ADMINISTRATOR/
DIRECTOR:		PAZ, DIANAFACILITY TYPE:
740
ADDRESS:240 PALM AVETELEPHONE:
(530) 661-0574
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 100CENSUS: 68DATE:
12/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Diana Paz, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:03 AM
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Licensing Program Analyst (LPA)Jill Nakagawa arrived unannounced and met with Diana Paz, Administrator. The purpose of the visit was to conduct an inspection, check on the Plans of Correction on past deficiencies and to amend page 9099-D for complaint investigation 21-AS-20241007152406, originally filed on 11/26/24.

LPA toured the facility and found it to be clean and sanitary. There were residents involved in a self-led exercise class. The facility has hired a new Activities Director, currently in training, so regular activities led by staff will be beginning within a few days.

Residents in Memory Care were clean and dressed appropriately. Most were in the Activity/Dining Room watching an old movie together, although several were doing individual activities at small tables.

LPA went over Plans of Correction with Administrator, staffing, the new Activities Director, and amending past report.

In addition, LPA requested recent copies of the call bell system for the last 10 days and shower sheets for Memory Care for 11/10/2024 through 12/10/2024.

There were no deficiencies found at the time of inspection. No citations issued.

Exit interview conducted with Administrator.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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