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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202903
Report Date: 11/12/2024
Date Signed: 11/12/2024 02:00:03 PM

Document Has Been Signed on 11/12/2024 02:00 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 OF CUPERTINOFACILITY NUMBER:
435202903
ADMINISTRATOR/
DIRECTOR:		TAYEBEH, TINA BAGHERIFACILITY TYPE:
740
ADDRESS:581 E FREMONT AVETELEPHONE:
(408) 962-2982
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 134CENSUS: 80DATE:
11/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Tina BagheriTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
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Licensing Program Analysts (LPAs) Christine Dolores and Santino Fortes arrived at the facility unannounced to conduct a case management – other visit. LPA met with Executive Director, Tina Bagheri.

The purpose of the visit is to hand deliver an immediate exclusion letter for an individual (S1) who the Department determined engaged in conduct inimical as a staff in the facility. The letter was handed to the Executive Director. The Executive Director states S1 was immediately terminated after the incident on 11/07/2024.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Executive Director, Tina Bagheri and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
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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