<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430708734
Report Date: 11/27/2024
Date Signed: 11/27/2024 03:30:10 PM

Document Has Been Signed on 11/27/2024 03:30 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:SUNRISE MANOR RESIDENTIAL CARE HOMEFACILITY NUMBER:
430708734
ADMINISTRATOR/
DIRECTOR:		AIDA MIRANDAFACILITY TYPE:
740
ADDRESS:790 & 792 LOS PADRES BLVD.TELEPHONE:
(408) 615-0999
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY: 6CENSUS: 5DATE:
11/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Lead Staff, Maylinda SorianoTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit to follow up on the Type A and Type B deficiencies cited on 9/24/2024. LPA Rai met with Lead Staff, Maylinda Soriano and stated the purpose of today's visit. Lead Staff notified Licensee/Administrator Aida Miranda of LPAs' visit and S1 stated Licensee/Administrator was not available at the time and unable to be present during today's visit. LPA Rai observed 2 staff and 5 residents in the facility.

During today's visit, LPA Rai inspected the backyard and observed the exits were free of obstruction. LPA Rai observed the exit doors and window screens of residents' rooms are clean and in good repair. LPA Rai observed two sheds containing gardening tools were locked and inaccessible to residents in care.

LPA Rai inspected the kitchen and hallway and the air vents were covered with new vents. LPA Rai inspected the kitchen refrigerator and did not observe medications unlocked and accessible to residents' in care.

During visit, LPA Rai provided letter of the Deficiency Citations cleared.

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

This report was reviewed with Lead Staff, Maylinda Soriano and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2024
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 1