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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201169
Report Date: 09/13/2023
Date Signed: 09/13/2023 12:41:01 PM

Document Has Been Signed on 09/13/2023 12:41 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 CARE HOMEFACILITY NUMBER:
019201169
ADMINISTRATOR:LU, YANFACILITY TYPE:
735
ADDRESS:20112 REDWOOD RDTELEPHONE:
(510) 703-8063
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 7CENSUS: 0DATE:
09/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Xiang (David) Lin, Administrator TIME COMPLETED:
12:50 PM
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On 09/13/2023 at 10:45 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Xiang (David) Lin and explained the purpose of the visit. The facility’s fire clearance was approved for 8/26/2023.

LPA toured facility with David including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 0 bedrooms are occupied by the clients and 0 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. The hot water temperature in the client shared bathroom was measured at 106 degrees Fahrenheit. Client bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 04/12/2023. Emergency Disaster Plan was last posted on 9/22/2022. First aid kit was observed to be complete.

No files review because LPA observed that facility doesn’t have any clients nor staff.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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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