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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601455
Report Date: 08/26/2020
Date Signed: 08/27/2020 02:32:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:REDWOOD ROAD CARE HOMEFACILITY NUMBER:
015601455
ADMINISTRATOR:LIN, XIANG(DAVID)FACILITY TYPE:
740
ADDRESS:20112 REDWOOD ROADTELEPHONE:
(510) 703-8063
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY:14CENSUS: 5DATE:
08/26/2020
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Xiang Lin, AdministratorTIME COMPLETED:
12:00 PM
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A conference call was conducted today to discuss plans on how to address issues at this facility in connection with the Non Compliance Conference held yesterday, August 25, 2020.

Participants of the call were Isaac Taggart, Regional Manager, Harpreet Humpal, Licensing Program Manager, David Lin, Administrator, Yvonne Flores-Larios, Licensing Program Manager and LPA Luisa Fontanilla.

LPA Fontanilla read to Administrator the plans as indicated in Lic 9111 including but not limited to increase monitoring of the facility and a referral to the legal division for review.

Administrator states he understands the plans discussed.

Copy of this report will be sent to Administrator via email and certified mail.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020
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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