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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601455
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:41:49 PM


Document Has Been Signed on 04/21/2022 03:41 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, 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: 0DATE:
04/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Xiang Lin (David) Adninstrator TIME COMPLETED:
03:45 PM
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On 4/21/22 at 3:05pm, Licensing Program Analysts (LPAs) K. Nguyen, and L. Francisco arrived unannounced to conduct Infection Control Inspection. LPAs met with Administrator, David Lin and explained the purpose of the visit. There are currently no residents at the facility.

During the Infection Control Inspection, LPAs toured facility with David Lin including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. Prior to accepting new residents, LPAs advised Administrator to post proper infection control posters at all handwashing stations, kitchen and common areas. Facility has a mitigation plan on file.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
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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