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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202780
Report Date: 07/10/2025
Date Signed: 07/10/2025 04:45:35 PM

Document Has Been Signed on 07/10/2025 04:45 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:SONNET HILLFACILITY NUMBER:
435202780
ADMINISTRATOR/
DIRECTOR:		LATU, JASMINEFACILITY TYPE:
740
ADDRESS:429 MERIDIAN AVETELEPHONE:
(408) 731-0019
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY: 80CENSUS: DATE:
07/10/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Administrator, Jasmine LatuTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Case Management to address deficiencies observed during today's complaint visit. LPA met with Administrator, Jasmine Latu and stated the purpose of the visit.

During today's visit, LPA Rai observed 3 resident rooms (R1-R3) with Health and Wellness Director (HWD) Ann Lee. At 1:03pm, LPA Rai and HWD entered R1's room and observed centrally stored medications and over the counter medications on the kitchenette counter and cabinet below. HWD stated she was not aware of the medications R1 kept in the cabinet. R1 showed medications placed in a 7-day medication storage. Based on review of R1's Physician's Report dated 5/19/2025, R1 cannot administer and store own medication. HWD confirmed R1 does not have physician's order on file to allow R1 to administer or store own medication and facility staff did not assess resident to ensure residents’ safety would not be at risk if allowed access to store own medications.

At 1:10pm, LPA Rai and HWD entered R2's room and observed expired prescription topical cream on a bookshelf near the room's entrance. LPA Rai observed PRN medication on another bookshelf near the room's entrance. LPA Rai observed laundry/cleaning solution on the floor near the room's entrance. HWD stated the facilty staff assist with administer resident's medication and R2 should not have access to medication. HWD immediately removed the expired medication and PRN medication. HWD stated Hospice agency aide and family assist with R2's laundry therefore they use the laundry/cleaning solution which is located in the room. HWD stated the laundry/cleaning solution will be kept inaccessible to resident in the resident's room. Based on review R2's LIC 602A Physician's Report dated 6/19/2023, R2 is not able to administer or store own medications.
Continuation on LIC 809-C, Page 1 of 2.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Simranjit Rai
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: SONNET HILL
FACILITY NUMBER: 435202780
VISIT DATE: 07/10/2025
NARRATIVE
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Page 2 of 2.

At 1:21pm, LPA Rai and HWD entered R3's room and did not observe any medications or chemicals accessible to resident in care.

Deficiencies were cited at this time as per California Code of Regulations, Title 22, please see LIC 809-D.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with Administrator, Jasmine Latu and a copy of the report was provided. Appeal Rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Simranjit Rai
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 07/10/2025 04:45 PM - It Cannot Be Edited


Created By: Simranjit Rai On 07/10/2025 at 03:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: SONNET HILL
FACILITY NUMBER: 435202780

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/11/2025
Section Cited
CCR
87465(a)(4)

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87465 Incidental Medical and Dental Care (a)(4) The licensee shall assist residents with self-administered medications as needed.
This requirement was not met as evidenced by:
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Administrator stated to submit a written plan of action understanding regulation and will ensure R1 is assisted with medications by POC due date. Administrator agreed and understood.
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Based on observation, record review and interview, the facility staff did not assist R1 with medications as needed when LIC 602A states R1 is not able to administer or store own medication which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.
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Type A
07/11/2025
Section Cited
CCR87465(h)(4)

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87465 Incidential Medical and Dental Care (h)(4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label.This requirement was not met as evidenced by:
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Administrator stated to submit a written plan of action understanding regulation and will ensure medications are not expired and discarded after date stated on prescription by POC due date. Administrator agreed and understood.
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Based on observation, and record review, the facility staff did not discard R2's medication after expiration date and was still present in R1's room which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Simranjit Rai
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 07/10/2025 04:45 PM - It Cannot Be Edited


Created By: Simranjit Rai On 07/10/2025 at 03:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: SONNET HILL
FACILITY NUMBER: 435202780

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/11/2025
Section Cited
CCR
87465(h)(2)

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87465 Incidental Medical and Dental Care (h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
This requirement is not met as evidenced by:
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Administrator stated to submit a written plan of action understanding regulation and will ensure centrally stored medications are kept in a safe and locked place inaccessble to residents in care by POC due date. Administrator agreed and understood.
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Based on observation and record review, R2 medications were accessible to R2 who is not able to store own medication which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.
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Type A
07/11/2025
Section Cited
CCR87309(a)

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87309(a)... the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances...which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
This requirement is not met as evidenced by:
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Administrator stated to submit a written plan of action understanding regulation and will ensure cleaning solutions are in locked storage and not left unattended by POC due date. Administrator agreed and understood.
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Based on observation and record review, laundry/cleaning solution was observed in R2's room left unattended outside of locked storage which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Simranjit Rai
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2025


LIC809 (FAS) - (06/04)
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