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ICF/DD-H (Habilitative)License activeMedi-Cal certified

WOODBRIDGE ICF

ICF/DD-H (Habilitative) · 6 licensed beds · Woodbridge, CA

Homes of 4–15 beds for people with developmental disabilities whose nursing needs are intermittent and predictable.

Address

WOODBRIDGE ICF528 INDIANA STREETWoodbridge, CA 95258 · San Joaquin County

Phone: (209) 333-1327

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-H (Habilitative)
Licensed beds
6
Licensee
ARYSA, LLC · Limited Liability Company
Administrator
MARCOS, LUZ
CDPH facility ID
100001768
License number
100000757
First licensed
August 1, 2001
Current license
Nov 1, 2026 to Oct 31, 2027
CDPH district office
Stockton

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
55G408
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
December 17, 2001
Last certification survey
January 22, 2025
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Recertification
Ownership type (CMS)
Private (proprietary)
Certified beds (CMS)
6
Staffing reported to CMS
RN 1 · LVN/LPN 1 · direct care 8 · all employees 9

State citations and penalties (CDPH)

CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained

No state citations or penalties on record for this facility in CDPH's enforcement data (July 1998 to date).

Federal inspections (CMS-2567)

15 surveys since 2018 · CMS data through Oct 12, 2026

CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection

Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").

  1. · Recertification

    Event 9WI521 · 1 deficiency

    Official 2567 ↗
  2. · Recertification

    Event 9WI511 · 2 deficiencies

    Official 2567 ↗
  3. · Recertification

    Event 9BFP21 · 3 deficiencies

    Official 2567 ↗
  4. · Recertification

    Event 9BFP11 · 7 deficiencies

    Official 2567 ↗
  5. · Complaint

    Event 0LUI11 · no deficiencies cited

    Official 2567 ↗
  6. · Recertification

    Event 6GMQ21 · 8 deficiencies

    Official 2567 ↗
  7. · Recertification

    Event 6GMQ11 · 3 deficiencies

    Official 2567 ↗
  8. · Recertification

    Event CNE521 · 4 deficiencies

    Official 2567 ↗
  9. · Recertification

    Event CNE511 · 3 deficiencies

    Official 2567 ↗
  10. · Focused Infection Control, Other-Fed

    Event GTP411 · no deficiencies cited

    Official 2567 ↗
  11. · Focused Infection Control, Other-Fed

    Event VK5Y11 · no deficiencies cited

    Official 2567 ↗
  12. · Recertification

    Event UE4U21 · 1 deficiency

    Official 2567 ↗

From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.

Complaints and reported incidents

CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.

Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.

Open this facility on CalHealthFind ↗How to file a complaint with CDPH

Change history

16 events, newest first

Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.

  1. ReportFederal survey (recertification): 1 deficiency(state record)

    See this survey →
  2. ReportFederal survey (recertification): 2 deficiencies(state record)

    See this survey →
  3. ReportFederal survey (recertification): 3 deficiencies(state record)

    See this survey →
  4. ReportFederal survey (recertification): 7 deficiencies(state record)

    See this survey →
  5. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  6. ReportFederal survey (recertification): 8 deficiencies(state record)

    See this survey →
  7. ReportFederal survey (recertification): 3 deficiencies(state record)

    See this survey →
  8. ReportFederal survey (recertification): 4 deficiencies(state record)

    See this survey →
  9. ReportFederal survey (recertification): 3 deficiencies(state record)

    See this survey →
  10. ReportFederal survey (focused infection control, other-fed): no deficiencies(state record)

    See this survey →

Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.