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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200234
Report Date: 02/09/2023
Date Signed: 02/09/2023 04:28:10 PM

Document Has Been Signed on 02/09/2023 04:28 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SUNRISE HOMEFACILITY NUMBER:
435200234
ADMINISTRATOR:MENDOZA, AURORAFACILITY TYPE:
735
ADDRESS:2046 LAVONNE AVENUETELEPHONE:
(408) 272-0587
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY: 6CENSUS: 5DATE:
02/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Lourdes CeraTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management Visit and conducted an Infection Control Check at the facility.

During visit, LPA Marrufo observed there to be a 30-day supply of PPEs. There was a visitor screening area at the facility. The facility had a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. Cleaning supplies were stored in a locked area. The outside area exits were clear of obstructions.




No deficiencies were cited at this time as per California Code of Regulations Title 22.


This report was reviewed with Lourdes Cera and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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