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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 210102866
Report Date: 07/25/2024
Date Signed: 07/25/2024 10:20:29 AM

Unfounded


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
07/05/2024 and conducted by Evaluator Helena Rummonds
COMPLAINT CONTROL NUMBER: 21-AS-20240705102809
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: DATE:
07/25/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Kyle Ruth-IslasTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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Facility staff is not allowing authorized representative to view resident's medical records
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 9:30AM to deliver findings regarding the above allegation. LPA met with Administrator, Kyle Ruth-Islas. LPA and Administrator discussed the purpose of the visit.

Throughout the course of the investigation, LPA conducted interviews and reviewed documents.

Complaint alleges that facility staff are not allowing authorized representative to view resident's medical records. Based on documents reviewed, Resident 1 (R1) designated a specific individual as their Power of Attorney (POA), Health Care Agent, Trustee, and Executor of Will. Review of documents revealed that R1 and POA gave instructions to facility not to give out medical or personal information to an outside party, who was not authorized to view the documents they requested.

Continued on LIC9099
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Helena RummondsTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 21-AS-20240705102809
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: 07/25/2024
NARRATIVE
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Continued from LIC9099

Based on review of documents and interviews conducted these allegations are UNFOUNDED. A finding that the complaint is UNFOUNDED means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.
SUPERVISOR'S NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Helena RummondsTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2