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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202623
Report Date: 03/03/2021
Date Signed: 03/03/2021 02:51:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:SUNRISE ASSISTED LIVING OF PALO ALTOFACILITY NUMBER:
435202623
ADMINISTRATOR:FLAVIO SILVAFACILITY TYPE:
740
ADDRESS:2701 EL CAMINO REALTELEPHONE:
(703) 273-7500
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:97CENSUS: 67DATE:
03/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Flavio SilvaTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) David Marrufo and HFEN Nurse Shahla Taleban conducted a tele-visit via Zoom to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility. LPA Marrufo, and HFEN Nurse Shahla Taleban met with Administrator Flavio Silva.

The Administrator reports that there are currently 0 COVID-19 positive residents and 1 COVID-19 positive staff.

During today's tele-visit, the following recommendations were made to the facility by HFEN Nurse Shahla Taleban:

1. Place social distancing sign on 1st floor elevator
2. Socially distance all hallway chairs and benches on all floors
3. Have outgoing staff shift monitor incoming shift for temperature and symptoms
4. Only use trash cans with foot pedal-operated lids
5. Place COVID-19 related signs in dining and kitchen areas

No deficiencies were cited as per California Code of Regulations, Title 22.

This report was reviewed with with Administrator Flavio Silva. A copy of the report will be sent to him for it to be signed and returned to CCL.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021
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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