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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 576804285
Report Date: 02/20/2025
Date Signed: 02/20/2025 11:18:29 AM

Document Has Been Signed on 02/20/2025 11:18 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:WALFORD RESIDENTIAL CARE 2FACILITY NUMBER:
576804285
ADMINISTRATOR/
DIRECTOR:		WALFORD, APRILFACILITY TYPE:
740
ADDRESS:1212 WEST STTELEPHONE:
(530) 360-9497
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 6CENSUS: 0DATE:
02/20/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Licensee/Administrator April Walford and
Rohan Walford, Licensee		TIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived and met with Licensees April and Rohan Walford. The purpose of this visit is to conduct a Pre-Licensing inspection. The fire clearance has been approved for 6 non-ambulatory adults.

The facility is a one story home with 4 bedrooms for residents, family room, 2 bathrooms. laundry room and kitchen. The grounds of the facility were fenced and there was a shaded area available for residents use. There is a built-in pool in the back yard, which is fenced and secured, making it inaccessible to residents. There were no firearms on the property. The fire extinguisher was last inspected on 02/13/2025 and fully charged. There were 5 Smoke and 1 carbon monoxide detector which were tested and appeared to be operational. An emergency disaster plan was submitted, and the applicant has identified at least two evacuation locations.

LPA observed locked cabinets for sharps and medications. Kitchen was clean and well-equipped with an adequate supply of dishes and utensils. Refrigerator was clean, with perishable and non-perishable foods. Two additional refrigerators will be housed in the garage, one for perishables and one for medications (which will be secured). Bathrooms had slip mats and grab-bars for resident safety. Hand washing supplies and paper products were available by sinks used by residents. Water temperature was between 105-120 degrees F, which is within regulation. A tour of residents' bedrooms was conducted and bedrooms inspected have lighting & appropriate furnishings and linens.
LPA observed the following postings: personal rights, emergency disaster drills, and the Let Us Know Complaint poster.

LPA conducted a COMP 3 with applicants; some of the following items were discussed: Administrator Qualifications, Reporting Requirements, Maintenance

Continued on 809-C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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: WALFORD RESIDENTIAL CARE 2
FACILITY NUMBER: 576804285
VISIT DATE: 02/20/2025
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Continued from 809....

and Operation, Personal Accommodations, Criminal Background clearance.

LPA found no concerns. There were no deficiencies found at the time of inspection.


This pre-licensing is complete. LPA will submit the pre-licensing reports to Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status. A copy of the report was given to the Applicant.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
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