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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803736
Report Date: 07/22/2021
Date Signed: 07/22/2021 10:40:50 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:SUNRISE VILLA SONOMAFACILITY NUMBER:
496803736
ADMINISTRATOR:CORNEJO, WENDYFACILITY TYPE:
740
ADDRESS:91 NAPA RDTELEPHONE:
(707) 939-1500
CITY:SONOMASTATE: CAZIP CODE:
95476
CAPACITY:105CENSUS: 64DATE:
07/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator, Wendy CornejoTIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Erik Gonzalez Campos conducted an unannounced Required – 1 Year inspection on July 22, 2021. LPA was greeted by staff and was asked to sign in after being screened for COVID symptoms. There are currently 49 residents in assisted living and 15 in memory care.

LPA toured assisted living and memory care beginning at 9:15 AM. LPA observed hand sanitizer and COVID postings throughout. The facility was found to be clean and a comfortable temperature. There was an ample supply of linens, cleaners, hygiene products and paper products available for residents. Toxins were inspected and are located in locked cabinets as well as in closets throughout the building. LPA observed the necessary personal protective equipment (PPE) to support a resident in isolation. All bedrooms are private therefore residents could isolate in their own bedroom if necessary. High touch surface areas are disinfected daily. Medication is primarily stored in locked medication carts as well as in locked office.

Staff were observed wearing masks. Administrator confirmed staff were N95 fit tested as well as trained on infection control and PPE usage by facility nurse. Facility has a 100 percent vaccination rate for staff and over 70 percent vaccination rate for residents and has therefore discontinued surveillance testing per CCL guidelines. Residents are screened daily for COVID symptoms. Mitigation plan has been received and reviewed by CCL. Residents' emergency contact information has been updated and administrator confirmed staff are familiar with 911 procedures and protocols

Facility is allowing residents to have meals in the dining room and furniture is set up for social distancing. Common areas are also set up for social distancing. LPA and administrator discussed resident activities which include card games, exercises, and visiting musicians. Visits are occurring primarily in resident bedrooms. Administrator confirmed residents are screened upon returning from outings.

Continued on LIC 809C
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: SUNRISE VILLA SONOMA
FACILITY NUMBER: 496803736
VISIT DATE: 07/22/2021
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Administrator and LPA discussed facility Emergency Disaster Plan and confirmed it is current. LPA observed the installation of a generator during visit and requested written notification to CCL with time frame for completion.

No deficiencies cited during this inspection
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
LIC809 (FAS) - (06/04)
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