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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201400
Report Date: 02/13/2025
Date Signed: 02/13/2025 02:05:49 PM

Document Has Been Signed on 02/13/2025 02:05 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:SUNNY ORCHARD PLACEFACILITY NUMBER:
435201400
ADMINISTRATOR/
DIRECTOR:		THERESA CARRFACILITY TYPE:
740
ADDRESS:1155 POME AVENUETELEPHONE:
(408) 737-2474
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 6CENSUS: 6DATE:
02/13/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Luisa Regala and Ofelia GuanzonTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On February 13, 2025, at 12:15 PM, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Plan of Correction (POC) visit. Upon arrival, the LPA was greeted by the DSP, Luisa Regala. The LPA disclosed the purpose of the visit. The DSP informed the LPA that there were (6) residents in care. The DSP accompanied the LPA during the inspection. Administrator, Ofelia Guanzon joined shortly after.

On 01/10/2025, the LPA conducted a Case Management – Other inspection at the facility. During the inspection, the LPA observed two units will walls and doors constructed in the garage. The deficiency was issued, and the plan of correction was developed with the licensee. The Licensee will submit the evidence of building permit and fire clearance for the garage alteration. If neither is obtained, the Licensee will demolish (2) units from the garage and submit photographic evidence to CCLD by 01/17/2025.



POC was due on 01/17/2025, but as of today (02/13/2025), the LPA has not received a POC from the licensee. On 01/17/2025, LPA emailed the licensee asking the licensee to email the facility sketch with the alteration / construction in the garage. LPA didn’t receive any email reply from the licensee. On 01/21/2025, LPA emailed the licensee again asking for the updated sketch of the garage and reminded licensee that the POC was due on 01/17/2025.

Today (02/13/2025) at 12:30 PM, the LPA inspected the garage in the presence of the caregiver and observed the doors have been removed, but the walls are still there in the garage. LPA observed (4) closets, (2) mirrors, (1) table lamp, (1) sofa, (1) chair, (1) table, (1) electrical lamp mounted on one of the added walls with on/off switch on the added walls with electrical wires running within the walls, (2) baskets with personal clothes, (2) wet towels hanging from closets, (3) suitcases, and multiple storage containers.

LPA inspected wooden chest placed inside the area of these walls, under the electrical lamp and mirror. LPA observed personal federal tax return form for Staff (S1) in top drawer of the chest, prescribed medication bottles for S1, hair and other personal products in the second drawer, personal clothes in the third drawer of the chest.

Continued on LIC809-C

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: SUNNY ORCHARD PLACE
FACILITY NUMBER: 435201400
VISIT DATE: 02/13/2025
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On 02/13/2025, LPA talked to the licensee, Theresa Carr on the phone and the licensee stated they would send the updated facility sketch with the additions/alterations/construction done in the garage by 02/17/2025.

A civil penalty was assessed for $100 per day for the period of 01/18/2025 to 02/13/2025 totaling $2,700 for a violation regarding the alterations done in the garage and not submitting POC by the due date of 01/17/2025, see LIC421FC. The civil penalty will continue to accrue $100 per day until the deficiency is corrected.

An exit interview was conducted, and Plan of Correction was reviewed with the Administrator. A copy of this report, civil penalty, and appeal rights were discussed and left with the Administrator, Ofelia Guanzon, whose signature on this form confirms receipt of these documents.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC809 (FAS) - (06/04)
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