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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201400
Report Date: 03/11/2025
Date Signed: 03/11/2025 11:51:42 AM

Document Has Been Signed on 03/11/2025 11:51 AM - 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: 5DATE:
03/11/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Luisa RegalaTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
NARRATIVE
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On March 11, 2025, at 10:55 AM, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Plan of Correction (POC) 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 (5) residents in care. The DSP accompanied the LPA during the inspection. Assistant Administrator, Ofelia Guanzon joined shortly after.

On January 10, 2025, LPA conducted a Case Management – Other inspection at the facility. During the inspection, LPA observed two units with walls and doors constructed in the garage. As a result, a deficiency was cited under Regulation 87305 – Alterations to Existing Buildings or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. A Plan of Correction (POC) was developed with the licensee, requiring them to submit evidence of a building permit and fire clearance for the garage alteration. If neither was obtained, the licensee was required to demolish the two units in the garage and submit photographic evidence to CCLD by January 17, 2025.

On January 17, 2025, LPA emailed the licensee requesting a facility sketch showing the alterations/construction in the garage. However, LPA did not receive a reply. A follow-up email was sent on January 21, 2025, again requesting the updated sketch and reminding the licensee that the POC was overdue.

On February 13, 2025, LPA conducted a POC visit. During the visit, LPA inspected the garage in the presence of the caregiver and observed that the doors had been removed, but the walls were still there in the garage. LPA observed (4) closets, (2) mirrors, (1) table lamp, (1) sofa, (1) chair, (1) table, (1) electrical lamp mounted on one of the added walls with on/off switch on the added walls with electrical wires running within the walls, (2) baskets with personal clothes, (2) wet towels hanging from closets, (3) suitcases, and multiple storage containers.

Continued on LIC809-C

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: SUNNY ORCHARD PLACE
FACILITY NUMBER: 435201400
VISIT DATE: 03/11/2025
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As a result of the ongoing violation and the failure to submit the POC by the January 17, 2025, deadline, a civil penalty of $100 per day was assessed for the period from January 18, 2025, to February 13, 2025, totaling $2,700.

On February 14, 2025, LPA received an email from Assistant Administrator Ofelia Guanzon, which included an updated facility sketch showing the alterations and conversion of the garage.

On February 24, 2025, an inspector from the City of Sunnyvale Neighborhood Preservation office inspected the facility and determined that the prohibited walls installed in the garage and the floor of the garage consist of an unapproved surface for parking, requiring removal of the prohibited walls in the garage and removal of the existing flooring.

On March 1, 2025, the facility demolished the prohibited walls and flooring in the garage.

Today (03/11/2025) at 11:15 AM, LPA conducted a follow-up inspection of the garage in the presence of a caregiver and observed that the walls in the garage had been demolished and removed. As a result, the previously cited deficiency “87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit” was cleared on this date.

No deficiencies were cited today under the California Code of Regulations, Title 22.

An exit interview was conducted with the Assistant Administrator. A copy of this report was discussed and left with the Assistant Administrator, Ofelia Guanzon, whose signature on this form confirms receipt of this report.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
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