<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202358
Report Date: 06/29/2021
Date Signed: 06/30/2021 09:28:00 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:SUNRISE ASSISTED LIVING OF MONTEREYFACILITY NUMBER:
275202358
ADMINISTRATOR:PAUL L. HARRISONFACILITY TYPE:
740
ADDRESS:1110 CASS STTELEPHONE:
(831) 643-2400
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:112CENSUS: 76DATE:
06/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Paul Harrison and Maria BonilliaTIME COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Marybeth Donovan conducted an unannounced Annual Required 1 Year Infection Control site visit and met with Paul Harrison Administrator and Maria Bonillia LVN Wellness Nurse.

LPA toured the facility inside and out to include the lobby, kitchen, bistro, dining room, living room, activity room, Reminiscence-Memory Care, Terrace Club, bathrooms and exterior. All fire exit routes were free and clear of obstructions. Medications are stored in a locked medication room. Toxins, cleaning supplies, knives and sharp objects are secured. Interior temperature 71 degrees Fahrenheit and first floor common area bathroom water temperature 113 degrees Fahrenheit.

In the kitchen LPA observed a minimum of 2 day perishable food supply and 7 day non perishable food supply.

Facility observed to have designated entry point for universal symptom screening. All restrooms observed to be supplied with hygiene products. Hand washing signs were posted in bathrooms. Hand sanitizer available to residents. Facility observed to have adequate supply of Personal Protective Equipment (PPE). Staff observed wearing masks.

LPA reviewed the facility policies and procedures to include screening, isolation, disinfecting, staffing, training, supplies, PPE usage and social distancing.

No citations were issued per the California Code of Regulations, Title 22.

LPA reviewed report with Maria Bonillia LVN Wellness Nurse and a copy provided,
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marybeth DonovanTELEPHONE: (408) 726-4301
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1