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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
415600874
Report Date:
05/03/2023
Date Signed:
05/03/2023 12:54:52 PM
Document Has Been Signed on
05/03/2023 12:54 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 CITY
FACILITY NUMBER:
415600874
ADMINISTRATOR:
MONICA CERON TAPIA
FACILITY TYPE:
740
ADDRESS:
485 WOODSIDE RD
TELEPHONE:
(650) 366-3900
CITY:
REDWOOD CITY
STATE:
CA
ZIP CODE:
94061
CAPACITY:
130
CENSUS:
72
DATE:
05/03/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:15 AM
MET WITH:
Monica Tapia
TIME COMPLETED:
01:00 PM
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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management visit in conjunction with a complaint visit made on this day. LPA met with the administrator and explained purpose of today's visit.
LPA met with and discussed the assessments and appraisals for R1 upon return to the facility after being out of the facility and with family for approximately two weeks. According to the administrator the care plan and needs of the resident was communicated to the responsible party accordingly. Medications for R1 are handled by the facility not the wife of the resident. R1 has a private care giver from an outside agency that is now stationed in the room of R1 due to the decline in his health and the falls that have occurred. The private caregiver also ensures that the medications of R1's wife is locked and inaccessible to R1. According to the administrator the wife refuses to be assessed. Physician's report for the wife of R1 is dated in 2022 and confirms she is able to self manage her medication. LPA collected pertinent documents in person on this day from the facility.
Report is reviewed with the administrator Monica.
SUPERVISOR'S NAME:
Cara Smith
TELEPHONE:
(650) 266-8800
LICENSING EVALUATOR NAME:
Jaime Vado
TELEPHONE:
(559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE:
05/03/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/03/2023
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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