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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700830
Report Date: 04/26/2023
Date Signed: 04/26/2023 10:54:05 AM

Document Has Been Signed on 04/26/2023 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
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:REDWOOD SENIOR CAREFACILITY NUMBER:
342700830
ADMINISTRATOR:SMEU, CHRISTINEFACILITY TYPE:
740
ADDRESS:9502 ORANGEVALE AVE.TELEPHONE:
(847) 544-8760
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 6CENSUS: 6DATE:
04/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Christine Smeu: AdministratorTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 4/26/2023 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with Administrator, Christine Smeu, and explained the purpose of the visit.

At 9:35 AM, LPA and administrator toured the interior and exterior of the facility to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, six (6) residents bedrooms, (3) full bathrooms, four (4) half bathrooms, kitchen, garage and backyard. LPA observed required furniture, and lighting throughout the residents' bedrooms and facility. LPA observed residents' bathrooms to be clean, sanitary, and in good repair. LPA observed food supplies of non-perishables for a minimum of one (1) week and perishable foods for a minimum of two (2) days. Toxic and cleaning supplies locked and is inaccessible to residents in care. The hot water temperature was measured in the kitchen at 110 degrees Fahrenheit. First aid kit was completed. LPA observed fire detectors and carbon monoxide alarms to be in working order. The fire extinguisher was last serviced on 08/16/2022. LPA observed medications to be locked and inaccessible to residents in care. LPA observed required Licensing posters posted throughout the facility.

At 9:50 AM, LPA reviewed a total of three (3) resident files. Resident files contain signed admission agreements, physician's reports, identification sheets, releases, and resident's rights. Medications are centrally stored, locked, and appear to be given per doctor order. LPA compared medications to those being given for three (3) residents and found no discrepancies. Facility is correctly using the Medication Administration Records (MAR). LPA reviewed a total of one (1) staff record. Staff has training in medications, first aid and CPR, and other various areas of care provision.

LPA requested for administrator to submit documents listed below to Community Care Licensing.
  • LIC 500
  • LIC 308
  • Administrator Certificate
  • Updated LLC Statement of Information

No deficiencies are being cited. Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Sarena Keosavang
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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