<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236800285
Report Date: 02/15/2022
Date Signed: 02/15/2022 11:06:37 AM

Document Has Been Signed on 02/15/2022 11:06 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
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:
02/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jill RexrodeTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At approximately 10:15 AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this licensed facility unannounced to conduct an Annual Required infection control inspection. This inspection will focus on the Infection Control procedures and practices of this facility. LPA met Executive Director Jill Rexrode and toured the building. The program is not currently operating due to Covid precautions. LPA reviewed the health and safety practices of the facility. Facility will contact LPA when the program reopens.

No citations issued during this visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1