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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803958
Report Date: 01/27/2021
Date Signed: 01/27/2021 01:32:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:REDWOOD SANTA ROSAFACILITY NUMBER:
496803958
ADMINISTRATOR:CARDENAS, CRISANTEFACILITY TYPE:
740
ADDRESS:1727 BURBANK AVETELEPHONE:
(415) 810-0145
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:22CENSUS: 12DATE:
01/27/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Anthony Barbato (Applicant)TIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Cuadra conducted an unannounced subsequent Pre-licensing Inspection due to change of ownership via video conferencing due to Covid-19 precautions with Applicant, Anthony Barbato, Administrator, Crisante Cardenas. Applicant was available by phone and gave authorization to Crisante Cardenas to sign the report. A Pre-Licensing inspection was completed on 1/26/2021. POC received from Pre-licensing and readings for all bathrooms were under regulation, deficiency is cleared.

Pre-licensing passed and COMP III completed. Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulation.

LPA will notify CAB of today’s Pre-licensing inspection.

No deficiencies cited at today’s inspection.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2021
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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