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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600874
Report Date: 08/12/2022
Date Signed: 08/12/2022 12:06:56 PM


Document Has Been Signed on 08/12/2022 12:06 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:BROOKDALE REDWOOD CITYFACILITY NUMBER:
415600874
ADMINISTRATOR:MONICA CERON TAPIAFACILITY TYPE:
740
ADDRESS:485 WOODSIDE RDTELEPHONE:
(650) 366-3900
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:130CENSUS: 79DATE:
08/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monica Ceron TapiaTIME COMPLETED:
12:15 PM
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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management visit regarding an incident that took place on 8/2/2022. LPA met with administrator Monica Ceron Tapia to discuss this.

According to Monica there was an incident that occurred where a person in plain clothes entered the facility through a side entrance where a family member exited from. This side entrance is not an entrance to the facility as it is marked as an exit only. The suspect bypassed the front entrance and did not sign in as per protocol. Video footage was reviewed and it was confirmed that is how the suspect gained entry into the facility. LPA observed this footage as well. A private contractor that was hired to work in the beauty salon reported to Monica that she was missing some of her personal belongings. Monica stated that she advised the contractor to contact the Police Department. While the officers were on site on the 5th floor with the contractor, R1 reported to Moncia that someone was in her room going through her belongings. When the administrator was speaking to R1 the suspect came to the office of the administrator as well and she was questioned by Monica on her identity. The suspect made up a name of someone she was visiting in the facility but the facility did not have a resident by that name. The suspect got upset with Monica and she exited the building. Monica followed the suspect to a car parked in the facility parking lot where there was another suspect sitting in the drivers seat. Monica took pictures of the suspects, of their car, and license plate. Redwood City Police was on site when the suspect was in the facility but had left by the time officers got down to the ground floor after being alerted. Monica provided the information to the officers on site. Monica found out that another resident in the room next to R1 said the same person was in her room and attempted to take the resident's blood pressure but the resident declined and the suspect left her room and went to the room of R1. Officers inspected the rooms of R1 and R2 and per Monica no items were taken according to the the residents. LPA discussed future preventative measures with Monica to prevent this from happening in the future.

A police report number of the incident was received by LPA on this day.

No citations issued. Report reviewed with the administrator Monica.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2022
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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