435202903-7-22-2025-26-AS-MPAA-DKESPK-20250810140317

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202903
Report Date: 07/22/2025
Date Signed: 07/22/2025 02:28:43 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2025 and conducted by Evaluator Christine Kabariti

COMPLAINT CONTROL NUMBER: 26-AS-20250131095320

FACILITY NAME:	SUNRISE OF CUPERTINO		FACILITY NUMBER:	435202903
ADMINISTRATOR:	TAYEBEH, TINA BAGHERI		FACILITY TYPE:	740
ADDRESS:	581 E FREMONT AVE		TELEPHONE:	(408) 962-2982
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	134	CENSUS: 88	DATE:	07/22/2025
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Tina Bagheri		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Facility staff did not properly assist resident with hygiene needs
Facility staff did not allow resident to wear their own clothing of choice

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding for the above allegations. LPA met with Executive Director, Tina Bagheri.

On 01/31/2025, the Department received a complaint regarding the above allegations. On 02/04/2025, the initial complaint investigation was conducted. Documents were obtained for this investigation to include resident (R1)’s physician’s report, pre-appraisal, and needs and services plan.

It was alleged that the staff did not properly assist resident (R1) with hygiene needs as it was stated that the staff did not encourage the resident to change into clean clothing. Page 1 of 3.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 26-AS-20250131095320

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SUNRISE OF CUPERTINO	FACILITY NUMBER: 435202903
	VISIT DATE: 07/22/2025

NARRATIVE

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It was also alleged that the staff did not allow R1 to wear their own clothing of choice because the staff chooses it for him/her, including undergarments as it was stated that the staff are only giving R1 pull ups options instead of underwear.

6 staff members were interviewed. Based on staff interview, it was stated that when R1 first transitioned into the memory care unit the staff were made aware by R1’s family that R1 had tendencies to shuffle his/her clean and dirty clothes and reuse dirty clothes. During R1’s transition into memory care, the facility’s approach with R1 was orienting him/her to the new environment before implementing hands on care, as R1 was previously not receiving any hands-on care. It was stated that staff continued to supervise, monitor, provide stand-by assistance, and provide R1 with verbal cues and reminders when necessary.

Staff stated that when they observed R1 was reusing his/her dirty clothing, the staff would verbally prompt R1 to change his/her clothes. It was stated that R1 had a certain clothing item that he/she liked to wear and if he/she saw it in the dirty pile, R1 would take it and wear it. The facility staff informed R1’s family (authorized representative) of their concerns.

Staff stated that when they tried to verbally redirect R1 from reusing dirty clothing, R1 would get verbally aggressive with staff and ask staff to leave him/her alone as he/she was “not a kid”.

After discussing the concern with R1’s authorized representative, the facility staff and R1's authorized representative agreed to separate R1’s clothes in storage bins and place a lock on the dirty clothing bin to prevent R1 from getting into his/her dirty clothes. Staff stated since implementation of the clean/dirty storage bins, it has helped reduce R1 reusing dirty clothing.

5 out of 5 staff members stated that the staff are trained to provide residents who are unable to fully decide for themselves 2 options of outfits to choose from.
Page 2 of 3.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20250131095320

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SUNRISE OF CUPERTINO	FACILITY NUMBER: 435202903
	VISIT DATE: 07/22/2025

NARRATIVE

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5 out of 5 staff members stated that staff pick 2 outfit options for R1 to choose from. It was stated that R1 is able to decipher whether he/she likes the outfits, and staff would continue to show options until R1 agrees to it.

5 out of 5 staff members stated that R1 has the option of using either pull ups or underwear. It was stated that R1 has the option of choosing which option he/she wants to wear, however, is encouraged to wear pull ups for precautionary measures.

On 02/04/2025, R1 was interviewed. Based on interview, R1 stated that he/she can wear the clothes that he/she wants and is able to change his/her own undergarments.

On 02/04/2025, LPA Chang observed that R1’s closet was unlocked and accessible to R1. LPA observed a locked box of laundry in R1’s bedroom. LPA observed R1’s clothing was clean.

On 05/20/2025, LPA Kabariti observed R1’s clothing looked clean with no observation of obvious stains and foul odor. LPA observed R1’s closet contained 2 large storage bins with 1 of the bins labeled “dirty clothes”. R1’s closet observed with a few blouses that were hung.

Based on record review, R1 requires dressing assistance. It’s indicated that R1 tends to reuse clothing. The facility plans to assist resident with putting away dirty clothes at the end of each day into the laundry basket/hamper. R1 also requires physical assistance with bathing and has preferred shower days of 2 times per week.

The Department has investigated the above allegations. Based on interview, record review and observation the above allegations are unfounded, meaning, the allegations are false, could not have happened and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Tina Bagheri and a copy of the report was provided. Page 3 of 3.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025

LIC9099 (FAS) - (06/04)

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