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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202623
Report Date: 09/04/2020
Date Signed: 09/04/2020 02:47:39 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:SUNRISE ASSISTED LIVING OF PALO ALTOFACILITY NUMBER:
435202623
ADMINISTRATOR:SAULNIER, AMYFACILITY TYPE:
740
ADDRESS:2701 EL CAMINO REALTELEPHONE:
(703) 273-7500
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:97CENSUS: 78DATE:
09/04/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Caroline FrangiehTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management - Incident visit over telephone and spoke with Caroline Frangieh. The meeting was conducted over telephone due to the ongoing COVID-19 Shelter-in-Place order throughout the county and state. The reason for the visit was to follow up on an incident report that the facility filed with CCL on 06/22/2020 and cross-reported as an SOC341 report to Adult Protective Services and Long-Term Care Ombudsman. The incident involved a case of suspected financial abuse of resident R1 by R1's family member. LPA Marrufo conducted this Case Management visit in order to update the facility on the latest activities that CCL has taken on the incident and to inquire if the facility has any further updates regarding the incident.

On 08/27/2020, LPA Marrufo cross-reported the incident to Bureau of Medi-Cal Fraud & Elder Abuse, Santa Clara County Adult Protective Services, Santa Clara County Ombudsman, Palo Alto Police Department, and the Social Security Administration. LPA Marrufo confirmed with Santa Clara County Adult Protective Services that an investigator is currently working on the case.

During visit, LPA spoke with Caroline Frangieh and discussed the activities that the facility has taken to investigate the incident.

No deficiencies were cited at this time. This report was reviewed with Caroline Frangieh and a copy of the report will be sent to her to sign and return to CCL.
SUPERVISOR'S NAME: George NwaforTELEPHONE: (408) 324-2116
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2020
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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