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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 181300554
Report Date: 04/26/2023
Date Signed: 04/26/2023 05:09:59 PM

Document Has Been Signed on 04/26/2023 05:09 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
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
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: 2DATE:
04/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Carrie LindemanTIME COMPLETED:
04:20 PM
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
LPA Hiratsuka conducted this unannounced annual visit. LPA toured the facility with Licensee/Administrator Carrie Lindeman.

This facility has three resident rooms and two rooms for private use by the licensee. There are two full common bathrooms and one full private bathroom. There is a kitchen, main common area, an art area, and a storage area that has the nonperishable food, and other items.

LPA observed the following today:
-the hardwood floors are worn and has some stains, but is clean.
-the floors in the resident rooms are clean and stain free
-the main common area has a t.v. and dining table for people to eat.
-There is a side room that has a table and is used for art.
-the resident files are complete
-the staff files are complete.
-there are disaster drills and fire drill logs
-nonperishable food supply is ample


Discussed today is that an age exception is required because the residents are over the age of 60. LPA left a copy of the regulations with instructions for the exception.
Several other topics were discussed

no deficiencies cited.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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