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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600874
Report Date: 01/31/2024
Date Signed: 01/31/2024 03:13:38 PM


Document Has Been Signed on 01/31/2024 03:13 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
SAN BRUNO RO, 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: 66DATE:
01/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator MonicaTIME COMPLETED:
03:30 PM
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On 01/31/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - incident visit. LPA met with administrator and explained the purpose of this visit.

Per SOC341 received on this day during an annual inspection, LPA and administrator discussed this incident. SOC341 was being submitted and incident report report to the Department on this day regarding a family member yelling at a resident over the weekend on 01/27/2024 who is their sibling that resides in the facility. Caregiver witnessed this in response to a call light to the resident's room. Caregiver tried to de-escalate the incident as the resident's health and safety was in jeopardy. The family member did not allow staff to assist the resident and the report was made regarding the incident to appropriate staff and the Department. Facility spoke with the resident to understand what happened and a resolution is being worked out between family member and resident. Resident has been monitored for any changes in condition.

SOC341 was received in person on this day. Incident report will be sent to the Department on this day.

No citations issued.

Report discussed with administrator.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024
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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