The Redwoods

Type of visit: Case Management - Annual Continuation

License Program Analyst (LPA) Shannan Hansen arrived unnanounced at approximately 9:00 AM to complete an annual inspection that started on 9/23/2025. LPA met with Elena Davidenko, COO/ Administrator & Will Orellana, facility director. There is a total of 112 residents. LPA and facility director conducted inspections of 12 residents apartments, retesting bathroom faucets finding hot water temperatures measured between 99.5 degrees F and 130.6 degrees F falling out of Title 22 acceptable regulation of 105 to 120 degrees F in 6 of 12 resident’s bathroom faucets, 3 of which in memory care unit, while touring facility on 9/25/2025 at 9:30 AM (see LIC809D). Although bathroom showers have required grab bars and some have mats and chairs, most showers do not have slip resistant flooring as observed by LPA and facility director. Facility director indicated will work on solution to keep residents safe from harm (see LIC9102TA). A sample review of ten resident & six staff records was conducted. LPA reviewed resident’s files at 10:30 AM on 9/25/2025 and learned that 10 out of 10 residents have an updated reappraisal/needs & care plan on file as well as medical assessments at this time as required by Title 22 Regulation. Medications were centrally stored in a locked medication cart in the facility medication room and in locked medication cart in Memory Care Unit nurses station. Medications and the process were reviewed and inspected. The facility uses electronic medication administration. LPA conducted a sample reviewed of staff records at 11:45 AM on 9/25/2025 and learned that all facility staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions. In addition, Direct care staff have received the additional training requirements as per Title 22 Regulations and H&S Code. Continue on LIC809C Continued from LIC809 LPA was presented with proof of CPR & 1st Aid certification for all staff although staff (S1) did not have proof of 1st Aid (see LIC 809D). Record review also revealed 3 staff (S2, S3, & S4) did not have TB results and S3 & S4 did not have health screening (see LIC809D). Disaster Drills are conducted quarterly with the last one being conducted on 9/10/2025. Facility has full cite emergency generator. Elena Davidenko Administrator Certificate #7008072740 expires on 5/15/2027. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 10/17/2025: LIC 308 Designated LIC 309 Administrative Organization LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Sep 25, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Sep 26, 2025

87303(e)(2) Maintenance & Operation. Hot water provided for the use of resident shall be maintained between 105 and 120 degrees F. This requirement is not met as evidenced by: Based on observation the facility did not have hot water temperature between 105 &.. .. 120 degrees F in 6 of 12 resident's bathroom faucets ( 3 in memory care at 128 and up) which poses an immediate Health and Safety risk for residents in care. LPA & facility dir. at retesting observed hot water temperature between 99.5 (1) & 120.9 and up in 5 others. degrees F.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Facility to ensure hot water temperature is maintainted within regulation - 105 to 120 F. Facility to submit a LIC 9098 self certification that hot water has been adjusted within regulation by POC date 9/26/2025 along with plumbing receipt & begin monitoring for the next 10 days. Administrator/facility director to submit a 10 day log taken from the residnet's bathrooms to CCL by 10/6/2025. ***Faility adjusted hot water during the visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c) · Plan of correction due date: Oct 3, 2025

87411(C)(1) Personell Requirements, General- All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. Based on LPA's staff record reviews, staff S1 lack required first aid certification, the licensee did not comply with the section cited above in [1] out of [3], which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Licensee/Administrator to ensure staff S1 obtain required first aid certification. Submit proof of first aid certification no later than 10/3/25 to clear citation.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(f) · Plan of correction due date: Oct 3, 2025

87411(f)Personnel Requirements – General All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. This requirement is not met as evidenced by: Based on review of records, Staff S3 & S4 did not have a health screening report, including TB test and results & S2 did not have TB results. the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Licensee/administrator to schedueld staff S3 & S4 to obtain a health screening, and including S2 including a TB test, and results. Licensee to submit copies of the documents by POC due 10/3/25 to LPA. If there are complications Licensee to contact LPA.

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct annual inspection visit of the facility. LPA was welcomed by CEO Kyle Ruth-Islas, Administrator Elena Davidenko arrived shortly after. Facility’s fire clearance granted by Southern Marin Fire Department on 6/6/2025 for 150 residents 35 nonambulatory, 12 of which in new memory care unit, also cleared for 2 exterior areas of memory care unit, each with egress doors and Noc Box for fire department. Facility approved for Hospice waiver of 8. There is a total of 112 residents, 13 of which have dementia diagnosis. There are 3 residents currently on Hospice. LPA toured the facility on 9/23/2025 at 10:30 AM with Administrator, CEO and Will Orellana,facility director; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguishers were found to be last charged on 1/24/2025 at the time of the visit. Facility hallway smoke detectors are hard wired and sound directly to fire station. Smoke detectors, carbon monoxide, and fire sprinklers are inspected, and inspection records are current, with the last being conducted on 8/4/2025. There are emergency lights in many of the fixtures in the common areas of the facility that come on should a power outage occur. Hot water temperature measured between 104.3 degrees F and 124.8 degrees F falling out of Title 22 acceptable regulation of 105 to 120 degrees F in 5 of 12 resident’s faucet bathrooms while touring facility. Although LPA was informed plumber was on site working on water heaters and when reinspected most were in range. Will recheck at return visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations at the time of the visit, covered, labeled, and dated. LPA toured kitchen area and learned that there are provisions made for individuals/residents with special dietary needs. Food is available for residents any time of the day. There is a daily activity schedule for residents. Toxins are stored in locked housekeeping rooms. There was a supply of cleaners, hygiene products and paper products available for residents. Continue on LIC 809-C Continued from LIC809 Bathrooms were equipped with necessary grab bars, and slip-resistant mats, strips, or flooring in all bathtub and shower floors as required by Title 22 regulations. A sample of twelve resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing. LPA initiated a file review of ten resident files and seven personnel files but were unable to complete. LPA was also unable to review medication and will return at a later date to complete annual inspection. No deficiencies cited during today's inspection.the state’s words, verbatim · CDSS document, Sep 23, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Loera, arrived unannounced to conduct a Case Management and met with Kyle Ruth-Salas, Executive Director. The purpose of the visit is to confirm an Order to Individual for Immediate Exclusion. The Department received an "immediate exclusion" notice on 06/24/2025. Per notice, Staff Member (S1) cannot be allowed to work, be present and/or live in a CCL licensed facility, or have contact with residents in any residential facility or child day care licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with residents and not allow this employee to be physically present in the facility. Executive informed LPA that S1 was removed from the facility and from the facility's staff roster on 06/24/2025 after receiving the notice. No Deficiencies Cited during visit. Exit interview conducted. Copy of report and LIC811 (Confidential Names) discussed and provided to Executive Director. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jun 25, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Hansen conducted an unannounced Health & Safety case management inspection and met with Kyle Ruth-Islas, Chief Executive Officer (CEO). The purpose of this case management is to conduct a walk through of the newly renovated building and grounds, Memory Care Unit of Building 7, consisting of 12 units, currently approved for 12 residents. There are no residents residing in this building at this moment. At approximately 9am tour of new memory care unit began with CEO & Director of Facilities, Taylor Kelly. LPA observed 12 apartments in this single-story building, having been recently remodeled, with dining/activity rooms, medication room, storage rooms with outdoor patios on each end of the unit. LPA toured 6 apartments which were found to be clean and at a comfortable temperature with all exits free from obstruction. All apartments have enclosed patios. All bedrooms were equipped with lighting/lamp, nightstand, and chest of drawers. Extra hygiene products and linens are available. Water temperature in sinks accessible to residents in care measured at 110.8 to 116.2 degrees F, within Title 22 regulations range of 105 to 120 degrees F. Resident bathrooms had required slip resistant flooring and grab bars. Smoke and carbon monoxide detectors observed to be operational. LPA observed cleaning supplies to be kept in locked laundry room across from nurses’ station, with dedicated staff 24/7. Nurses station also will contain centrally stored medications & med cart. There are pull cords in all bathrooms & next to beds that will announce to the nurses’ station and front lobby desk that is also occupied 24/7. Facility obtained 2 years ago commercial generator to supply entire premises should the power go out. Community Care Licensing (CCL) received STD850 form on 6/6/2025 approving fire clearance by The Southern Marin Fire Department for Building 7 Memory Care unit with egress doors and Noc Box for locked gate. Licensee has requested increase of Non-Am and 10 Bedridden, which is still under review by Fire Department. Facility is granted approval to occupy new memory care unit. No deficiencies cited during today’s inspection.the state’s words, verbatim · CDSS document, Jun 17, 2025

Allegation investigated: Staff are interfering with resident’s medical services.

On 03/18/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced visit for the purpose of delivering complaint findings. LPA arrived and met with Administrator, Elena Davidenko and Executive DIrector, Kyle Ruth-Salas. During the investigation, LPA reviewed records, conducted interviews with staff and outside parties, and made observations. Compliant alleges, Staff are interfering with resident’s medical services. Based upon department interviews with staff, information provided was contradicting with a lack of corroborating evidence to support the allegation. Individual 1 (I1) was a contracted podiatrist for the facility. The facility decided to go a different route and sign a new contracted podiatrist. Medical services such as podiatrist are provided for all residents upon their request, as facility has a sign-up sheet provided at facilities front desk. continued on LIC9099-C Unsubstantiated Stated in the facilities “Statement of Residents’ Personal Rights” Appendix F section I. Health and Safety Code Section 15669.269 (20) To select their own physicians, pharmacies, privately paid personal assistants, hospice agency, and health care providers, in a manner that is consistent with the resident’s contract of admission or other rules of the facility, and in accordance with this act. LPA was provided information during the investigation that a signed memorandum of understanding (MOU) for podiatry services was signed and residents in the facility may chose who they prefer for services. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, Mar 18, 2025 · control 21-AS-20241226115209

Type of visit: Case Management - Incident

At approximately 9:45am, Licensing Program Analyst (LPA) Loera arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator, Elena Davidenko and Executive Director, Kyle Ruth-Salas. The purpose of the visit was to follow up on a self-reported incident that was submitted to Community Care Licensing (CCL) on 12/26/2024. Incident report states on 12/25/2024 Resident 1 (R1) had pressed their emergency pendant in response to a fall to request staff assistance at approximately 2:49am. The security guard monitoring the system did not notify staff on duty of the alert and the call for assistance was not answered in a timely manner. (Deficiency Cited) Administrator conducted an in-service training on response protocols and training on pendant response. Deficiency was cleared during visit. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D (Deficiency Page), and Appeal Rights discussed and provided to Administrator.the state’s words, verbatim · CDSS document, Jan 29, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87415(a)(5) · Plan of correction due date: Jan 29, 2025

87415 Night Supervision (a) The following persons providing night supervision from l0:00 p.m. to 6:00 a.m...shall be available as indicated below to assist in caring for residents in the event of an emergency...(5) In facilities required to have a signal system, at least one night staff person shall be located to enable immediate response to the signal system. This requirement was not met as evidence by: Based on interview and document review, Administrator did not ensure that R1 was assististed in a timely manner.the state’s words, verbatim · CDSS document, Jan 29, 2025

Plan of correction: Adminstrator conducted an in-service training on response protocols and training on pendant response. Deficiency was cleared during visit.

Type of visit: Required - 1 Year

09/20/2024, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently 108 residents in care. Facility approved/cleared for 35 non-ambulatory and hospice waiver for 8. At approximately 9:50am, LPA and Administrator toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. LPA observed an emergency food supply. Medications were found to be centrally stored. All rooms were equipped with lighting, night stand, drawers. LPA observed an area of the facility to be under repair for future memory care use and is inaccessible to residents in care. Facility has scheduled activities for residents in care. Facility has residents with special dietary needs that are noted with resident’s names and their needs in the kitchen. Water temperature in sinks accessible to residents in care were measured at 119.4 and 118.4 degrees, within the range of 105 to 120 degrees F. Fire extinguishers were last inspected January, 2024. Smoke detectors, fire sprinklers, and carbon monoxide detectors located throughout the facility were last inspected June 11th, 2024. Toxins are stored in a locked housekeeping room. There was a supply of cleaners, hygiene products and paper products available for residents. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. At approximately 11:20 am, LPA conducted review of eight staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file. continued on LIC809-C At approximately 12:00 pm, LPA conducted a review of 8 resident records. All records had the required documentation. No deficiencies cited during today's inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility LIC610- Emergency Disaster Plan LIC9020- Register of Facility Client’s/Resident’s Copy of Certificate of Liability Insurance Exit interview conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 20, 2024

Allegation investigated: Facility staff is not allowing authorized representative to view resident's medical records

Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 9:30AM to deliver findings regarding the above allegation. LPA met with Administrator, Kyle Ruth-Islas. LPA and Administrator discussed the purpose of the visit. Throughout the course of the investigation, LPA conducted interviews and reviewed documents. Complaint alleges that facility staff are not allowing authorized representative to view resident's medical records. Based on documents reviewed, Resident 1 (R1) designated a specific individual as their Power of Attorney (POA), Health Care Agent, Trustee, and Executor of Will. Review of documents revealed that R1 and POA gave instructions to facility not to give out medical or personal information to an outside party, who was not authorized to view the documents they requested. Continued on LIC9099 Unfounded Continued from LIC9099 Based on review of documents and interviews conducted these allegations are UNFOUNDED. A finding that the complaint is UNFOUNDED means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 25, 2024 · control 21-AS-20240705102809

Type of visit: Case Management - Incident

At approximately 12:45PM Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced to conduct a case management inspection on an Incident Report that was received by Community Care Licensing (CCL) on 01/08/2024. LPA met with Administrator, Kyle Ruth-Islas, and discussed the purpose of the visit. Incident report states that Resident 1 (R1) has experienced multiple thefts that were not reported until 01/05/2024. Item #1 is a cashmere sweater valued at $600 that went missing in September of 2023. On December 29, 2023, R1 returned to their apartment and found their dresser drawers open and holiday trinkets were missing from open drawers. Items were not reported missing until 01/05/2024. On 1/05/2024, R1 and their family member was interviewed about the incident. R1's apartment was searched. Facility conducted an internal investigation with no findings. Facility contacted law enforcement to file a report. Facility has yet to review security footage. Administrator agreed to update LPA on any new information that is found when reviewing security footage. R1 has not reported any thefts since the incident. LPA requested R1's Physicians Report, which showed no diagnosis of Dementia or Mild Cognitive Impairment. LPA requested facilities internal investigation report. No deficiencies cited during inspection.the state’s words, verbatim · CDSS document, Jan 18, 2024