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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236800285
Report Date: 09/16/2021
Date Signed: 09/16/2021 03:40:25 PM

Document Has Been Signed on 09/16/2021 03:40 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
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:REDWOOD COAST SENIORS, INC.FACILITY NUMBER:
236800285
ADMINISTRATOR:ELIZABETH MORTONFACILITY TYPE:
775
ADDRESS:490 NORTH HAROLDTELEPHONE:
(707) 964-0443
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY: 30CENSUS: 0DATE:
09/16/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Jill RexrodeTIME COMPLETED:
03:45 PM
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At approximately 1:45 PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this licensed facility unannounced to conduct a case management visit. LPA met Executive Director Jill Rexrode and toured the building. The program is not currently operating. A covid mitigation plan is being worked on and will be submitted to CCL by 09/30/2021.

No deficiencies observed in the areas inspected. No citations issued.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2021
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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