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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200294
Report Date: 01/29/2025
Date Signed: 01/29/2025 01:20:42 PM

Document Has Been Signed on 01/29/2025 01:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:SUNRISE ASSISTED LIVING OF DANVILLEFACILITY NUMBER:
079200294
ADMINISTRATOR/
DIRECTOR:		KIRSTEN KORFHAGEFACILITY TYPE:
740
ADDRESS:1027 DIABLO RDTELEPHONE:
(925) 831-1740
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY: 89TOTAL ENROLLED CHILDREN: 0CENSUS: 67DATE:
01/29/2025
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH: Resident Care Director, Jeffery JacksonTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) A Gomez arrived unannounced to conduct a 1-Year Annual Required inspection on this date starting at 8:00AM. LPA met with Resident Care Director, Jeffery Jackson and explained the reason of the visit. The facility's fire clearance was approved for all may be non-ambulatory which 10 may be bedridden.

At 10:00 AM, LPA toured facility with Resident Care Director, including but not limited to apartments, bathrooms, kitchen, dining area, multiple activity rooms and courtyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the random residents’ bathroom were maintained at 117.6, 115.8, 116.4 and 109.8 degrees F. Residents’ bathrooms are equipped with grab bars and non-skid mats/non-skid shower pans. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication carts were inaccessible. Refrigerator temperature was maintained at 35 degrees F and freezer temperature is maintained at -15 degrees F.

Smoke detectors, carbon monoxide and sprinklers were observed throughout the facility. Fire extinguisher was last serviced on 1/25/2025 . Emergency Disaster Plan was last posted on 2/1/2024. First aid kit was observed to be complete. Fire drill was last conducted on 11/29/2024.

At 8:50AM, LPA reviewed 6 residents records. At 9:30pm, LPA reviewed 6 staff records and 6 of 6 staff are fingerprint cleared.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
Yvonne Flores-LariosTELEPHONE: (510) -28-0517
Alona GomezTELEPHONE: 510-239-1306
DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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