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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600897
Report Date: 03/20/2024
Date Signed: 03/20/2024 02:42:18 PM


Document Has Been Signed on 03/20/2024 02:42 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:REDWOOD ACRES RESIDENTIAL HOMEFACILITY NUMBER:
415600897
ADMINISTRATOR:SARMIENTO, ANNA MARISSA V.FACILITY TYPE:
740
ADDRESS:1728 REDWOOD AVENUETELEPHONE:
(650) 361-1014
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:6CENSUS: 5DATE:
03/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Caregiver - Carlos OrdonezTIME COMPLETED:
02:45 PM
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On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year annual inspection visit. LPA met with caregiver Carlos Ordonez and explained the purpose of today's visit.

This is a one level facility. Annual Fees are current. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored in the kitchen locked below the kitchen sink and according to the second caregiver on site, Agnes Abadicio, they also lock knives in the garage. Cleaning solutions are also locked below resident bathroom sink and in the garage. Perishable and non-perishable food items are observed as in place. LPA observed the medications as in place and locked in a cabinet in the kitchen. First aid kit is observed as complete with required items stored in the garage adjacent to the kitchen. LPA observed that the facility is equipped with fire extinguishers, smoke detectors, and carbon monoxide detectors that are placed through out the facility. Extinguishers were observed to have been inspected on 05/22/23. Central heating system is locked in hallway closet. PPE and additional food supplies are observed as in place in the garage. Laundry area is also observed as fully operational located in the garage. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Water temperature was measured at 105F. LPA observed several resident rooms at random and all rooms appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. COVID PPE and resident incontinence supplies are observed in place as well as resident linens being stored in resident rooms.

This annual inspection be continued at a later date to check facility on site records and files.

Report is reviewed with Carlos. No citations issued.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024
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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