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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201019
Report Date: 05/23/2024
Date Signed: 05/23/2024 04:07:48 PM

Document Has Been Signed on 05/23/2024 04:07 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 HOUSEFACILITY NUMBER:
435201019
ADMINISTRATOR/
DIRECTOR:
AJANI, GANIYUFACILITY TYPE:
735
ADDRESS:1221 SUNRISE WAYTELEPHONE:
(408) 586-9786
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 6CENSUS: 6DATE:
05/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Leah ContaoiTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Leah Contaoi.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the facility kitchen are and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed locked storage areas for cleaning supplies, sharps, and medications. LPA Marrufo observed the first aid kit and found it to be complete.

LPA Marrufo toured two out of two resident bathrooms and found the water temperatures to be 112 F. Each bathroom had available soap and paper towels as well as working lights.

LPA Marrufo toured 4 out of 4 resident bedrooms and observed each room to have functioning lights and available bedding and clothing storage areas. Facility staff tested the smoke detectors in each bedroom as well as in the hallways and living room areas. Each smoke detector functioned properly when tested. The carbon monoxide detector also functioned properly when tested.

LPA Marrufo reviewed the Personal and Incidental Monies Log for 6 out of 6 residents and found it to be balanced. LPA Marrufo reviewed the Centrally Stored Medications Log for 6 out of 6 residents and found it to be complete. LPA Marrufo reviewed resident and staff records and found them to be complete.

The Emergency Disaster Drill Log states the last drill was conducted on May 13th, 2024.

The outdoor area was toured and the exit was observed to be clear of obstructions. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Leah Contaoi and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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