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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803958
Report Date: 06/11/2021
Date Signed: 06/25/2021 01:19:57 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: 13DATE:
06/11/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Anthony Barbato (Licensee)TIME COMPLETED:
10:00 AM
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A Tele-Conference was conducted today due to Covid-19 precautions. Present in the meeting were Anthony Barbato (Licensee), Bill Keck (Licensee), Pam Gill (Assistant Program Administrator), Carla Nuti-Martinez (Regional Manager), Bethany Moellers (Licensing Program Manager) and Marisol Cuadra (Licensing Program Analyst).

This Conference is being conducted via Tele Visit to discuss concerns identified by the Community Care Licensing Agency regards to the operation of Redwood Santa Rosa # 496803958.



Licensing staff discussed temporary relocation of residents and it was determined that Licensee is working closely with the County to perform several repairs with different agencies to make necessary repairs to obtain clearance to relocate back to facility. Licensee is in the process to obtain a temporary relocation site, CCL encouraged to contact options in Sonoma County. Licensee agreed to notifies responsible parties prior to relocation to a new location. If licensee identifies a relocation site that currently obtains a CCL license, Licensee agrees to notifies CCL prior to move in and submit a written plan to how they will provide care and supervision. If relocation is to a non-licensed site, Licensee agrees to submit an application for change of location this includes submitting the following documents:

LIC200


LIC401, 401a, 403, 403a
LIC500
LIC999
LIC610 including transportation and evacuation.
Control of property (rental agreement)
Updates to the program design if necessary
New Fire Clearance
Licensee understand that Pre-licensing visit needs to be conducted prior to move residents in the property.

If Licensee is interested in obtaining an Assisted Living Waiver a link was provided for Licensee to get information about the Program: https://www.dhcs.ca.gov/services/ltc/Pages/AssistedLivingWaiver.aspx
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
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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