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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804226
Report Date: 06/06/2024
Date Signed: 06/06/2024 09:36:10 AM

Document Has Been Signed on 06/06/2024 09:36 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:REDWOOD COMMUNITYFACILITY NUMBER:
496804226
ADMINISTRATOR/
DIRECTOR:
MARTINEZ, ANTONIO JRFACILITY TYPE:
740
ADDRESS:8064 WHIPPOORWILL CTTELEPHONE:
(707) 591-1127
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 6CENSUS: 0DATE:
06/06/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:44 AM
MET WITH:Antonio Martinez (Applicant)TIME VISIT/
INSPECTION COMPLETED:
09:51 AM
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Licensing Program Analyst (LPA) Cuadra arrived announced to conduct a Pre-licensing Subsequent Facility Inspection and met with Applicant Antonio Martinez. A pre-licensing inspection was completed on 05/31/2024.

During today’s visit LPA observed the following items:

* Bedroom #1 has required furniture: bed, chair, lamp, and dresser.
* Bathroom #1 vent is rewired and/or replaced.
* Bedroom #2: Patchwork by the faceplate is painted.
* Bedroom #3 and #4 auditory signal alarms are installed on the door to alert staff.
* Bedroom #4 has regular bed in room.
* Bedroom #5 and #6 metal plate for closet door handle was installed.
* Half Bath cover installed in the ceiling.
* All bathrooms skid mats were placed in shower.
* Deck area debris was removed.
* Side gate bottom latch was removed.
* Water heater adjusted (110.7, 109.9 and 109.2), it is delivering required temperature of 105 to 120 F degrees as stated per regulation.

Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulation. LPA will notify Application Unit Pre-licensing inspection is complete to proceed with the process of license. Pre-Licensing items needed to be repaired have been resolved. Pre-Licensing is now complete.
No deficiencies cited at today’s inspection. Exit interview conducted with Applicant and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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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