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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600990
Report Date: 11/17/2020
Date Signed: 11/17/2020 05:24:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SUNRISE OF BURLINGAMEFACILITY NUMBER:
415600990
ADMINISTRATOR:ABBIE APOLINARIOFACILITY TYPE:
740
ADDRESS:1818 TROUSDALE DRTELEPHONE:
(650) 692-2805
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:97CENSUS: 66DATE:
11/17/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Abbie ApolinarioTIME COMPLETED:
05:00 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) Michael Garcia and Licensing Program Manager (LPM) Brenda Chan conducted an announced case management visit to this facility to provide a Technical Assistance (TA) regarding COVID-19. Due to COVID-19 pandemic, the visit was conducted remotely. Due to technical difficulties, the tele-visit was conducted via telephone call. The TA visit was conducted with Abbie Apolinario, executive director/administrator.

LPA discussed with Administrator the facility's COVID-19 infection control, mitigation and staffing plan.

According to Administrator, the facility currently has one (1) staff tested positive and one (1) staff tested negative for COVID-19. Both staffs are isolating at home and being monitored. The facility conducted mass testing of staff and residents on November 11, 2020 and November 12, 2020. All staff and residents tested negative for COVID-19. A second mass testing will be conducted on November 18, 2020 and November 19, 2020. The facility plans to resume the surveillance testing of 25% of its staff every 7 days after two rounds of negative test results for all facility staff and residents.

A case management continuation may be needed to conduct a virtual tour of the facility at a later date and time.

Licensing will be conducting daily calls to the facility to monitor its COVID-19 positive cases.

Report was discussed with Administrator. An electronic copy of the report was emailed to Administrator for signature.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Michael GarciaTELEPHONE: (650) 380-4608
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2020
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