415601114-12-16-2021-14-AS-JVAO-C9RVUG-20211216154442

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 415601114
Report Date: 12/16/2021
Date Signed: 12/16/2021 03:44:47 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 REDWOOD CITY		FACILITY NUMBER:	415601114
ADMINISTRATOR:	PADILLA, VERONICA		FACILITY TYPE:	740
ADDRESS:	1 EAST SELBY LANE		TELEPHONE:	(650) 885-7992
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94063
CAPACITY:	127	CENSUS: 0	DATE:	12/16/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Abbie Apolinario		TIME COMPLETED:	03:45 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	On this day at 1300hrs, Licensing Program Analysts (LPA) Jaime Vado and Komal Charitra conducted a announced prelicensing inspection visit. LPAs met with administrator Abbie Apolinario and senior vice president of operations for new developments Jason Englehorn and explained purpose of today's visit. This is a three floor facility that has two memory care units. There are 5 medication rooms through out the facility and one main kitchen. LPAs toured the entire facility. Temperature is taken and COVID screening questions were asked. Main dining room area is on the ground floor of the facility. Required signs regarding COVID, Ombudsman, and resident council rights are observed. Dining room is fully furnished with tables and chairs. Kitchen is adjacent to the main dining room. Kitchen is inspected as clean and in place. All kitchen appliances are in working order. ANSUL system, fire control panel, fire sprinkler system, and fire detection equipment have been inspected and approved with Redwood City Fire Department. Freezer and refrigeration units are observed as fully operational. Dry goods room is observed as in place adjacent to refrigeration units. Modified diets are accommodated for per kitchen ordering system. There are five resident rooms on the ground floor. Room 105 is observed. Pull cords are in place in all resident bathrooms and bedrooms. Non skid flooring is built in and built in folding shower chair. Furnishings can be provided upon request. Linens and towels are provided to residents. "Reminiscence" dementia area is observed on the ground floor. Room 117 was observed and water temperature is measured at 107F . "Fire doors are equipped on all resident rooms. All rooms are equipped with emergency lighting in rooms and bathrooms. Continued on next page...

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 REDWOOD CITY	FACILITY NUMBER: 415601114
	VISIT DATE: 12/16/2021

NARRATIVE

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Page 2 - Prelicensing

Second floor is toured. Room 213 is observed as furnished. Water temperature is measured at 115F. There is a dementia designated area on this floor referred to as the "Terrace Club" for mild to moderate residents with dementia. This area is key pad protected. Rooms are observed as vacant. There are 17 rooms in this area. This area has a designated medication room just for the residents in this area and a steam table for meals prepped by main kitchen to be brought up to this area. PPE and incontinence supplies are observed in this area. LPAs observed room 243 and is designated as shared room with two separate bedrooms but one bathroom. On this floor is a "wellness room" were resident records are stored.

Garage area/Lower level is considered a floor. This are houses the laundry room, parking area, emergency food supplies, and laundry room. Laundry room is observed as in order and fully functional. Facility is equipped with emergency back up generator that is rated to run for 72hrs.

Component 3 is conducted with administrator.

Facility is fully functional and in place. LPA will recommend licensure. No citations issued.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC809 (FAS) - (06/04)

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