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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202358
Report Date: 01/12/2022
Date Signed: 01/14/2022 08:52:54 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:
01/12/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Paul HarrsionTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Marybeth Donovan conducted an unannounced Case Management COVID 19 Inspection to include Infection Control and review of COVID 19 Mitigation Plan. LPA met with Paul Harrison Executive Director (ED) and toured the facility.

LPA observed a designated entry point for COVID 19 symptom screening. All restrooms observed to be supplied with hygiene products. Hand washing signs were posted in bathrooms. Hand sanitizer stations available throughout the facility. Facility observed to have a minimum 30 day supply of Personal Protective Equipment (PPE). Staff observed wearing surgical masks.

LPA reviewed the facility policies and procedures to include screening, face masks, visitation, dining, activities, social distancing, isolation, disinfecting, staffing, training, and PPE usage. All staff are N95 Fit Tested.

LPA interviewed ED and visitor.

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

LPA reviewed report with Paul Harrison Executive Director and a copy provided,
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marybeth DonovanTELEPHONE: (408) 726-4301
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2022
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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