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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201400
Report Date: 01/10/2025
Date Signed: 01/10/2025 02:21:06 PM

Document Has Been Signed on 01/10/2025 02:21 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:SUNNY ORCHARD PLACEFACILITY NUMBER:
435201400
ADMINISTRATOR/
DIRECTOR:		THERESA CARRFACILITY TYPE:
740
ADDRESS:1155 POME AVENUETELEPHONE:
(408) 737-2474
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 6CENSUS: 6DATE:
01/10/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Luisa RegalaTIME VISIT/
INSPECTION COMPLETED:
02:30 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
On January 10, 2025, at 12:40 PM, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Case Management – Other inspection visit. Upon arrival, the LPA was greeted by the DSP, Luisa Regala. The LPA disclosed the purpose of the visit. The DSP informed the LPA that there were (6) residents in care. The DSP accompanied the LPA during the inspection.

At 1:23 PM, LPA inspected the garage and observed two units will walls and doors constructed there. LPA reviewed the facility sketch and the sketch didn’t show two units in the garage. LPA talked to the Licensee over the phone and asked the Licensee for a building permit and fire clearance document for this construction/alteration to the garage. The Licensee stated they don’t have the building permit and the fire clearance document for the garage alterations.

A deficiency is being cited based on LPA observations, interviews, and records review conducted in accordance with the California Code of Regulations, Title 22, see LIC809D.

An exit interview was conducted, and the Plan of Correction was reviewed with the DSP. A copy of this report and appeal rights were discussed and left with the DSP, Luisa Regala, whose signature on this form confirms receipt of these documents.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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 2
Document Has Been Signed on 01/10/2025 02:21 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Kiran Jain On 01/10/2025 at 02:02 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: SUNNY ORCHARD PLACE
FACILITY NUMBER: 435201400

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
01/17/2025
Section Cited
CCR
87305(a)

1
2
3
4
5
6
7
87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The Licensee will submit the evidence of building permit or fire clearance for the garage alteration. If neither is obtained, the Licensee will demolish (2) units from the garage and submit photographic evidence to CCLD by 01/17/2025.
8
9
10
11
12
13
14
Based on observation, records review, and interview conducted, the licensee did not ensure to get permit/fire clearance for (1) garage alteration by constructing (2) units in the garage, which poses a potential health, safety or personal rights risk to persons in care
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:April Cowan
LICENSING EVALUATOR NAME:Kiran Jain
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2