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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600874
Report Date: 01/08/2025
Date Signed: 01/09/2025 09:16:39 AM

Document Has Been Signed on 01/09/2025 09:16 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BROOKDALE REDWOOD CITYFACILITY NUMBER:
415600874
ADMINISTRATOR/
DIRECTOR:		MONICA CERON TAPIAFACILITY TYPE:
740
ADDRESS:485 WOODSIDE RDTELEPHONE:
(650) 366-3900
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 130CENSUS: 73DATE:
01/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Patricia Melara, Assistant Executive Director TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 1/8/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 12:30 PM to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Patricia Melara, Assistant Executive Director and explained the purpose of the visit.

LPA Calandra toured the physical plant. This is a 3-story building with 108 bedrooms and bathrooms, a library, kitchen, dining room, lobby, and offices. Per interview with the Assistant Executive Director, the facility's fire alarm system is directly connected to the fire department. The facility's fire alarm panel was observed to be in working order. All bedrooms had the required furniture and sufficient lighting. The facility was maintained at a comfortable temperature. The facility had the required 7 days of non perishables and 2 days of perishables on hand. No food was expired.

During the visit, LPA collected the following documents:
  • Administrator Certificate

LPA Calandra reviewed 2 resident files and 6 staff files.

The Annual inspection will be completed at a later date.

Deficiencies are cited under the California Code of Regulations, Title 22. Failure to correct the deficiencies by the due date may result in civil penalties.

An exit interview was conducted. This report was reviewed with Patricia Melara, Assistant Executive Director and a copy of the report left at the facility.

SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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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Document Has Been Signed on 01/09/2025 09:16 AM - It Cannot Be Edited


Created By: John Calandra On 01/08/2025 at 04:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BROOKDALE REDWOOD CITY
FACILITY NUMBER: 415600874

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1569.311
ยง1569.311: Carbon Monoxide Detectors Required; inspection: Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview of facility's maintenance director, the facility does not have carbon monoxide detectors, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/09/2025
Plan of Correction
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Administrator/Licensee to purchase and install one or more Carbon Monoxide detectors in the facility and submit a plan of correction by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Andrea Medlin
LICENSING EVALUATOR NAME:John Calandra
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025


LIC809 (FAS) - (06/04)
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