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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 181300554
Report Date: 11/07/2023
Date Signed: 11/07/2023 05:04:15 PM

Document Has Been Signed on 11/07/2023 05:04 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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:
11/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Carrie Lindeman AdministratorTIME COMPLETED:
05:30 PM
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11/07/2023 03:00 PM Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrator Carrie Lindeman and explained the purpose of the visit.

LPA Benson and administrator toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to two (2) resident rooms, common areas, two (2) bathrooms, kitchen, storage areas and yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff files were reviewed. Medications were also reviewed.



Client bedrooms had required furniture, bedding, and lighting. The bathrooms were clean and in good repair. The kitchen in good repair. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Medication is locked in a locked closet.

First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared.

No firearms are on premises. The last disaster drill was conducted and documented on 08-04-23, the facility has been conducting drills every 3 months.

The annual will be continued at a further date due to time constraints.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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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