<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601374
Report Date: 09/13/2022
Date Signed: 09/13/2022 11:31:47 AM


Document Has Been Signed on 09/13/2022 11:31 AM - 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:RED MAPLE RESIDENTIAL HOMEFACILITY NUMBER:
075601374
ADMINISTRATOR:HELEN GRACE HERBERTFACILITY TYPE:
740
ADDRESS:7100 MANILA AVENUETELEPHONE:
(510) 778-9084
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:6CENSUS: 5DATE:
09/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Care Staff, Shierly FloresTIME COMPLETED:
11:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 09/13/22 at 11:30 AM, Licensing Program Analysts (LPAs) L. Holmes and M. Malik arrived unannounced to conduct a Pre-Licensing Inspection for CHOW to Rosewood Residence LLC. LPAs were greeted by one staff upon entry and explained the purpose of the visit. The Administrator, Araceli Emerick was telephoned by the Care Staff and is unavailable until 09/16/2022. Designated Care Staff, Shierly Flores will sign the report.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1