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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 12:54:35 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 discussed with Monica the medications administration policy at the facility and the basis for adding medication handling to the care plan of R1 which did incur an increase in fees. It was determined that upon entry to the facility R1 was able to self manage medications but due to R1 suffering a medical issue R1 is no longer able to self manage medications. Due to this change the facility assumed the responsibility as it is facility policy that if a resident cannot self manage medications the facility will store and manage the medications. LPA received past and current physician's reports for R1 to show the change in ability to mange medications as well as the policy the facility follows regarding such handling of medications.
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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