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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601455
Report Date: 05/25/2022
Date Signed: 05/25/2022 03:33:37 PM


Document Has Been Signed on 05/25/2022 03:33 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:
05/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Xiang "David" LinTIME COMPLETED:
03:50 PM
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On 5/25/2022 at 3:15 PM, Licensing Program Analyst (LPA) L. Francisco and K. Nguyen arrived unannounced to conduct a Case Management visit to obtain signature for a civil penalty assessed from amended complaint (CN# 15-AS-20200716113133) report that was issued on 12/28/2021. LPAs met with Administrator, Xiang "David" Lin and explained the purpose of the visit.

No deficiencies cited during visit. A copy of report provided to Administrator.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022
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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