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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 181300554
Report Date: 02/18/2022
Date Signed: 02/18/2022 02:29:53 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/18/2022 02:29 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:REDWINE FAMILY HOMEFACILITY NUMBER:
181300554
ADMINISTRATOR:LINDEMAN, CARRIEFACILITY TYPE:
735
ADDRESS:461-905 REDWINE LANETELEPHONE:
(530) 253-3287
CITY:JANESVILLESTATE: CAZIP CODE:
96114
CAPACITY: 6CENSUS: DATE:
02/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:TIME COMPLETED:
01:15 PM
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ON 02/18/2022 Licensing Program Analysts (LPAs) Misty Valencia and Dawn Keane arrived at the facility to conduct an unannounced required one year visit. Prior to visits LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted licensee and completed a facility risk assessment. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. LPAs was not able to complete annual due to licensee not being available. LPAs waited around until until 1:15pm. LPAs left business card and a voicemail on licensee's cell phone.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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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