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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210102866
Report Date: 01/18/2024
Date Signed: 01/18/2024 02:58:50 PM


Document Has Been Signed on 01/18/2024 02:58 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:REDWOODS, THEFACILITY NUMBER:
210102866
ADMINISTRATOR:KYLE RUTH-ISLASFACILITY TYPE:
740
ADDRESS:40 CAMINO ALTOTELEPHONE:
(415) 383-2741
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY:150CENSUS: 112DATE:
01/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator, Kyle Ruth-IslasTIME COMPLETED:
03:10 PM
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At approximately 12:45PM Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced to conduct a case management inspection on an Incident Report that was received by Community Care Licensing (CCL) on 01/08/2024. LPA met with Administrator, Kyle Ruth-Islas, and discussed the purpose of the visit.

Incident report states that Resident 1 (R1) has experienced multiple thefts that were not reported until 01/05/2024. Item #1 is a cashmere sweater valued at $600 that went missing in September of 2023. On December 29, 2023, R1 returned to their apartment and found their dresser drawers open and holiday trinkets were missing from open drawers. Items were not reported missing until 01/05/2024.

On 1/05/2024, R1 and their family member was interviewed about the incident. R1's apartment was searched. Facility conducted an internal investigation with no findings. Facility contacted law enforcement to file a report. Facility has yet to review security footage. Administrator agreed to update LPA on any new information that is found when reviewing security footage. R1 has not reported any thefts since the incident.

LPA requested R1's Physicians Report, which showed no diagnosis of Dementia or Mild Cognitive Impairment. LPA requested facilities internal investigation report.

No deficiencies cited during inspection.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Helena RummondsTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024
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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