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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201169
Report Date: 01/08/2024
Date Signed: 01/08/2024 12:33:19 PM

Document Has Been Signed on 01/08/2024 12:33 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 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:
01/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Xiang (David) Lin, Administrator TIME COMPLETED:
12:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced case management (post licensing). LPA met with Administrator (AD), Xiang (David) Lin and explained the purpose of the visit. LPA confirmed AD and follow up with AD on facility regrading no clients for the past years.

During the visit LPA toured the facility observed that there are currently no clients. The facility hasn’t had any client for the past two years. AD explained to LPA that AD been trying to get vendor by RCEB, but it’s been two years. AD will update LPA when AD have clients.

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

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2024
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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