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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600874
Report Date: 03/13/2023
Date Signed: 03/13/2023 11:56:29 AM


Document Has Been Signed on 03/13/2023 11:56 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
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: DATE:
03/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Monica 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 a break in that happened over the weekend. LPA met with administrator Monica Tapia regarding this incident.

According to her the break in happened on 03/12/2023 at around 1:30 am the suspect jumped a fence and entered the independent living building and burglarized a resident's room. Resident discovered the missing items and reported to facility staff in the early morning hours. According to Monica Redwood City Police Department was alerted and a formal report was taken. Video evidence was reviewed by RWCPD and staff of the burglary. No residents were injured. No other reports of missing items by residents in independent living were reported. Burglary suspect never entered the assisted living main building as video footage was able to confirm that the suspect exited the same route he entered.

Incident report is to be received on this day per the administrator. A police report number will also be provided.

No citations issued. Report is reviewed with Monica.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2023
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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