210102866-3-18-2025-21-AS-CMAZ-DEWT6E-20250319142700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 210102866
Report Date: 03/18/2025
Date Signed: 03/18/2025 03:15:47 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/26/2024 and conducted by Evaluator Anthony Loera

COMPLAINT CONTROL NUMBER: 21-AS-20241226115209

FACILITY NAME:	REDWOODS, THE		FACILITY NUMBER:	210102866
ADMINISTRATOR:	KYLE RUTH-ISLAS		FACILITY TYPE:	740
ADDRESS:	40 CAMINO ALTO		TELEPHONE:	(415) 383-2741
CITY:	MILL VALLEY	STATE: CA	ZIP CODE:	94941
CAPACITY:	150	CENSUS: 110	DATE:	03/18/2025
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Kyle Ruth-Salas, Executive Director Elena Davidenko, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff are interfering with resident’s medical services.

INVESTIGATION FINDINGS:

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On 03/18/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced visit for the purpose of delivering complaint findings. LPA arrived and met with Administrator, Elena Davidenko and Executive DIrector, Kyle Ruth-Salas. During the investigation, LPA reviewed records, conducted interviews with staff and outside parties, and made observations.

Compliant alleges, Staff are interfering with resident’s medical services.

Based upon department interviews with staff, information provided was contradicting with a lack of corroborating evidence to support the allegation. Individual 1 (I1) was a contracted podiatrist for the facility. The facility decided to go a different route and sign a new contracted podiatrist. Medical services such as podiatrist are provided for all residents upon their request, as facility has a sign-up sheet provided at facilities front desk.

continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5071
LICENSING EVALUATOR NAME: Anthony Loera	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20241226115209

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: REDWOODS, THE	FACILITY NUMBER: 210102866
	VISIT DATE: 03/18/2025

NARRATIVE

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Stated in the facilities “Statement of Residents’ Personal Rights” Appendix F section I. Health and Safety Code Section 15669.269 (20) To select their own physicians, pharmacies, privately paid personal assistants, hospice agency, and health care providers, in a manner that is consistent with the resident’s contract of admission or other rules of the facility, and in accordance with this act. LPA was provided information during the investigation that a signed memorandum of understanding (MOU) for podiatry services was signed and residents in the facility may chose who they prefer for services.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5071
LICENSING EVALUATOR NAME: Anthony Loera	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

LIC9099 (FAS) - (06/04)

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