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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210102866
Report Date: 07/26/2021
Date Signed: 07/26/2021 01:20:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:REDWOODS, THEFACILITY NUMBER:
210102866
ADMINISTRATOR:CATHERINE SCOTTFACILITY TYPE:
740
ADDRESS:40 CAMINO ALTOTELEPHONE:
(415) 383-2741
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY:150CENSUS: 122DATE:
07/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Maria del Rosario Dir of Clinical Nursing ServicesTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Shannan Hansen conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and was welcomed by William Orellana Executive Asst. to CEO & Maria del Rosario Director of Clinical Nursing Services. There were 122 residents present at the facility of a max capacity of 150.

LPA arrived at the facility and had her temperature checked and logged. All staff are temperature checked and logged each shift and wear masks. LPA toured the facility with Maria del Rosario Director of Clinical Nursing Services. During tour on 7/26/2021 with Maria del Rosario facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be last charged on 12/1/2020 at the time of the visit. Facility smoke detectors are hard wired and sound directly to the fire station. Smoke detectors and fire sprinklers are inspected annually, and inspection records are current with the last inspection being conducted on 10/13/2020. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Hot water temperature measured between 113.5 degrees F and 120 degrees F within acceptable regulations of 105 degrees F. to 120 degrees F. in resident’s bathroom faucets. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. At the end of LPA tour, Administrator Catherine Scott arrived to facility and answered further questions regarding Infection control and facility.

Infection Control:


Facility has submitted a mitigation program plan that has been approved. Posters have been placed at facility. Facility has PPE supply stored in nurse’s office and on-site storage facility. Residents’ medications are stored and locked in nurse’s station. Facility has a 30-day supply of medication for residents. Residents do not wear masks inside the facility.

Continue LIC 809-C
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-1410
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: REDWOODS, THE
FACILITY NUMBER: 210102866
VISIT DATE: 07/26/2021
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In addition, facility has a designated area for visitors outside which are being allowed for scheduled visits. Residents also have available zoom and telephone calls when contacting with family members and others. Staff had all PPE training required on file as well as N95 Fit Testing.

LPA reviewed Licensing Information System (LIS) with staff who stated that is correct and updated at this time. In addition, LPA advised facility to contact Marin County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or cases of COVID-19 +occur in the facility.

There were no deficiencies cited at this time.

SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-1410
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021
LIC809 (FAS) - (06/04)
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