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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803958
Report Date: 06/09/2021
Date Signed: 06/09/2021 03:43:09 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:
(707) 542-1940
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:26CENSUS: 21DATE:
06/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Cris Cardenas (Administrator)TIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to follow up on concerns about plumbing issues and met with Administrator, Cris Cardenas, Long Term Care Ombudsman Kathy Baldassari and Deb Jackson arrived later.

Upon LPA's arrival Code Enforcement were not present at the facility. Currently, there are 21 residents in care. Code Enforcement stated that residents in care and staff can't occupy the premises effective immediately until plumbing and sewage issue is resolved. Licensee informed that they will be implementing their Emergency Plan and will move residents in care to a local hotel and some residents will be staying with their responsible parties, LPA obtained a resident's roster and Licensee agreed to submit an updated roster of residents and temporarily locations by June 10, 2021 at 12pm to CCL including contact information of their responsible party and staff schedules.

Licensee agreed to implement the Emergency Plan to move the residents in care to a local hotel and ensure there is staff at all times to meet residents needs. Licensee will provide documents of all completed work and permits and CCL will conduct an on-site inspection.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021
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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