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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201317
Report Date: 12/03/2020
Date Signed: 12/10/2020 03:11:03 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:SUNNY VIEW RETIREMENT COMMUNITYFACILITY NUMBER:
435201317
ADMINISTRATOR:NELSON RODRIGUESFACILITY TYPE:
741
ADDRESS:22445 CUPERTINO ROADTELEPHONE:
(408) 454-5600
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:190CENSUS: 125DATE:
12/03/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Nelson Rodrigues and Adriana De La OTIME COMPLETED:
02:00 PM
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Licensing Program Manager Julio Montes, Licensing Program Analyst Joanne Roadilla and Health Facilities Evaluator Nurse (HFEN) Barbie Henson from the California Department of Public Health, conducted a tele-visit via Zoom to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility. LPM, LPA and HFEN met with Executive Director Nelson Rodrigues and Director of Health Services, Adriana De La O.

At around 1:30pm, LPM/LPA/HFEN virtually toured the residential living side of the community including the memory care (MC) unit. COVID-19 postings were visible throughout the facility. A screening station was observed at the central entry and hand sanitizers were observed in common areas at the facility. Social distancing guidelines are being implemented, some residents at the MC unit were observed watching TV and were seated at least 6 feet apart from each other. Staff were observed wearing masks and practicing social distancing.

HFEN suggested the following areas of infection control practices to prevent, contain, and mitigate the spread of COVID-19 at the facility:
1. Plan to designate an area for COVID-19 positive residents and have a dedicated staff with their own break room and bathroom so the facility can minimize co-mingling between positive and negative residents.
2. Replace the trash bins in bathrooms with lidded trash cans that are foot operated to prevent cross contamination.

This report was provided to Nelson Rodrigues and Adriana De La O for review then sign and mail back to CCL.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne RoadillaTELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020
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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