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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201198
Report Date: 10/14/2024
Date Signed: 10/14/2024 02:29:33 PM


Document Has Been Signed on 10/14/2024 02:29 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:SUNFLOWER CARE HOMEFACILITY NUMBER:
435201198
ADMINISTRATOR:VICTORIA REGALAFACILITY TYPE:
740
ADDRESS:631 TORRINGTON DRIVETELEPHONE:
(408) 733-6171
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:7CENSUS: 6DATE:
10/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Victoria Regala, AdministratorTIME COMPLETED:
03:00 PM
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On October 14, 2024, Licensing Program Analyst (LPA) Kiran Jain conducted an unannounced Plan of Correction (POC) visit to verify and confirm that the facility is in compliance with the citations issued during the annual inspection on October 3, 2024. LPA met with Victoria Regala and explained the purpose of the visit.

On 10/03/2024, the facility was cited for two deficiencies under the California Code of Regulation (CCR), 87355(e)(1) Criminal Record Clearance, and 87305(a) Alterations to Existing Building or New Facilities.

During the visit on 10/14/2024, LPA observed that the private caregiver (PC1) is no longer assisting the resident (R1) at the facility. The Power of Attorney (POA) of R1 has chosen not to hire PC1 for the R1’s care. If the POA decides to hire a private caregiver in the future, the licensee will ensure the caregiver undergoes fingerprinting clearance and is associated with the facility. The deficiency for CCR 87355(e)(1) is corrected and the citation is cleared.

LPA inspected the garage and observed that the two staff units in the garage have been demolished and cleared out. On 10/04/2024, the Administrator submitted photos via email to LPA, showing the staff units in the garage had been cleared and were no longer occupied. On 10/10/2024, the Administrator emailed LPA informing that the facility had decided to demolish the units in the garage. The deficiency for CCR 87305(a) Alterations to Existing Building or New Facilities is corrected and the citation is cleared.

No deficiencies were cited during the visit. The report is reviewed with Victoria Regala, and a copy is provided.

SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Kiran JainTELEPHONE: (650) 416-4836
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2024
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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