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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
415600897
Report Date:
12/08/2022
Date Signed:
12/08/2022 10:54:08 AM
Document Has Been Signed on
12/08/2022 10:54 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:
REDWOOD ACRES RESIDENTIAL HOME
FACILITY NUMBER:
415600897
ADMINISTRATOR:
SARMIENTO, ANNA MARISSA V.
FACILITY TYPE:
740
ADDRESS:
1728 REDWOOD AVENUE
TELEPHONE:
(650) 361-1014
CITY:
REDWOOD CITY
STATE:
CA
ZIP CODE:
94061
CAPACITY:
6
CENSUS:
DATE:
12/08/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Carlos Ordonez
TIME COMPLETED:
11:00 AM
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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management visit to amend a deficiency cited on 07/01/2022 and deliver the amended citation. LPA met with caregiver Carlos Ordonez and explained the purpose of today's visit.
LPA edited and delivered the amended LIC809D dated 07/01/2022 via email to the administrator Anna Sarmiento. LPA discussed the amended LIC809 with Anna via telephone.
No citations issued.
Report is reviewed with Anna via telephone.
SUPERVISOR'S NAME:
Cara Smith
TELEPHONE:
(650) 266-8800
LICENSING EVALUATOR NAME:
Jaime Vado
TELEPHONE:
(559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE:
12/08/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/08/2022
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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