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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700830
Report Date: 10/04/2023
Date Signed: 10/04/2023 11:07:28 AM


Document Has Been Signed on 10/04/2023 11:07 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:REDWOOD SENIOR CAREFACILITY NUMBER:
342700830
ADMINISTRATOR:SMEU, CHRISTINEFACILITY TYPE:
740
ADDRESS:9502 ORANGEVALE AVE.TELEPHONE:
(847) 544-8760
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:6CENSUS: 6DATE:
10/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Administrator: Christine Smeu TIME COMPLETED:
11:15 AM
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On 10/04/2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to conduct a Case Management- Incident to obtain information regarding an incident that occurred at the facility on 09/21/2023. LPA met with administrator, Christine Smeu, and explained the purpose of the visit.
The Case Management visit is in response to an incident report and Report of Suspected Dependent Adult/Elder Abuse (SOC 341) that was submitted to Community Care Licensing (CCLD). Incident report indicates, resident (R1) arrived at the facility after being discharged from the hospital with responsible party (RP). RP asked staff (S1) to assist R1 with transfer. S1 refused due to inability to lift. RP assisted R1 with transfer from bed to chair. RP notified administrator that RP witnessed S1 yelling at resident (R2) in care. The facility conducted an internal investigation and S1 was asked to take a leave of absence from direct patient care. Community Care Licensing and Long Term Care Ombudsman were notified.

On 09/21/2023, LPA Keosavang received a telephone call from acting administrator, Ingrid Smeu. Acting administrator reported the incident via telephone. LPA advised to provide training to all staff. Training on elder and dependent adult abuse and communication considerations when caring for person with Dementia were completed by all staff. The facility submitted training for review on 09/28/2023.



At this time, deficiencies are not being cited.

An exit interview conducted and report provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023
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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