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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201317
Report Date: 09/16/2020
Date Signed: 09/16/2020 04:22:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SUNNY VIEW RETIREMENT COMMUNITYFACILITY NUMBER:
435201317
ADMINISTRATOR:SALLY PLANKFACILITY TYPE:
741
ADDRESS:22445 CUPERTINO ROADTELEPHONE:
(408) 253-4300
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:190CENSUS: 108DATE:
09/16/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Nelson RodriguesTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Joanne Roadilla conducted an unannounced Case Management tele-visit via FaceTime today. The Department has suspended on site visits due to COVID-19 shelter in place order by Governor Newsom. LPA met with Executive Director (ED) Nelson Rodrigues.

The purpose of the tele-visit was to ensure the facility is continuing to adhere to COVID-19 infection control guidelines and preventive measures.

At 3:50pm, LPA toured the facility entrance and the memory care (MC) unit. COVID-19 postings and hand sanitizers were observed in common areas at the facility. LPA observed residents at the MC unit were watching TV and were seated at least 6 feet apart from each other. Staff were observed wearing masks and practicing social distancing. A hand washing station was available for staff and residents. ED stated that MC residents are always encouraged to wear masks, and if not able to, then staff assists residents to maintain social distancing.

LPA advised ED to consult with the Santa Clara County Public Health Department (SCCPHD) and the CA Department of Public Health (CDPH) for the most recent COVID-19 guidelines and for COVID-19 related concerns.

No deficiencies cited during today's tele-visit. Report was discussed with and a copy sent to Nelson Rodrigues to sign and mail back to CCL.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne RoadillaTELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2020
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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