Sunnybrae Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Unannounced Required Annual visit and inspection of the facility. LPA met with staff, Vivien Rono and explained the reason for the visit. The administrator, Jeffrey Sevella, joined shortly after. At approximately 12:00pm, LPA took a tour of the physical plant. The smoke alarms and carbon monoxide detector are dual and interconnected. There are two fire extinguishers located in the kitchen and dining room. The charge date is March 29, 2026. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food sealed and properly stored. Cleaning supplies and sharps are kept locked underneath the kitchen sink. Bedrooms: There are six (6) bedrooms designated for residents' use. Four bedrooms are private and one bedroom is shared. The resident bedrooms were observed to be properly furnished with appropriate beddings and linens with sufficient lighting and closet space. There is another room designated for staff use only. Bathrooms: There are four (4) bathrooms. Three is designated for residents' use. One is for staff. The bathrooms designated for resident use were properly supplied with functional fixtures, grab bars and non-skid mats. Hot water temperature was measured between 111 to 112 degrees Fahrenheit. No cleaning supplies are being stored in the three bathrooms. Common Areas: These included the living room and dining area. The living room is properly furnished with with adequate seating couches, tables, chairs and a television. There is a fireplace with a screen that is non-functional. No tools were present. There are two dining room tables, big enough to accommodate four (4) residents on each table Surrounding Grounds: Entry/exits were free of obstruction. Facility backyard is large with sufficient space. The backyard has furniture appropriate for outdoor use. There is a locked storage storage shed where tools and supplies are kept. There's no swimming pool or any other bodies of water. LPA did not observe any immediate health and safety risk. Garage: No Garage Laundry: The laundry area is located next to the kitchen. Detergents, cleaning supplies and cleansers were observed to be stored locked in cabinets. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medications are kept stored and locked in a cabinet by the kitchen. Medication and Medication Records were reviewed for proper storage and documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted. A Copy of the Report Issued.the state’s words, verbatim · CDSS document, Apr 10, 2026

Allegation investigated: Licensee admitted resident without conservator's approval. Staff did not seek medical attention for resident in a timely manner. Staff did not assist resident with care needs in a timely manner.

On 8/28/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an initial 10-day complaint visit to investigate the above allegations. Upon arrival, LPA met with the staff Josephine Espiritu, introduced herself by showing department badge and explained the reason for the visit. The Administrator was contacted over the phone and arrived shortly after. LPA disclosed the reason for the visit. Entrance interview conducted. At 11:00am, LPA requested and reviewed residents and staff rosters. At approximately 11:05am, LPA conducted a physical plant tour to ensure health and safety of the residents are protected. During the tour of the facility. LPA did not observe Resident #1 (R1) residing in the facility. Between 11:25am – 12:30pm, LPA conducted interviews with the Administrator, two (2) staff/caregivers, and two (2) out of four (4) residents residing at the facility who were able to communicate. Continue on LIC9099-C Unfounded Allegation: Licensee admitted resident without conservator's approval. It was reported by RP that Resident #1 (R1) was placed onto this board and care without approval of conservator. To investigate this allegation, LPA conducted interviews with the Administrator, two (2) staff members who denied the allegation and stated they never met R1 and that R1 never got admitted to the facility. The Administrator also stated that to admit a new resident, they follow and practice all the required Title 22 Regulations. Interviews with two (2) out of four (4) residents who were able to communicate, also confirmed they had never seen or heard of R1 living in the facility. LPA also reviewed residents’ roster which revealed that R1 was never admitted and currently is not residing at this facility. LPA have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. LPA have therefore dismissed the complaint. Allegation: Staff did not seek medical attention for resident in a timely manner. It was reported by RP that Resident #1 (R1) was discovered unresponsive, unable to open eyes, and appeared to be suffering from infection and dehydration. To investigate this allegation, LPA conducted interviews with the Administrator, two (2) staff members who denied the allegation and stated they never met R1 and that R1 never got admitted to the facility. Interviews with two (2) out of four (4) residents who were able to communicate also confirmed they had never seen or heard of R1 living in the facility. Residents stated they receive excellent care and supervision residing in this facility and never had any issues with staff members not providing medical attention on a timely manner. LPA also reviewed residents’ roster which revealed that R1 was never admitted and currently is not residing at this facility. LPA have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. LPA have therefore dismissed the complaint. Continue on LIC9099-C Allegation: Staff did not assist resident with care needs in a timely manner. It was reported by RP that Resident #1 (R1) was discovered unresponsive, unable to open eyes, and appeared to be suffering from infection and dehydration. To investigate this allegation, LPA conducted interviews with the Administrator, two (2) staff members who denied the allegation and stated they never met R1 and that R1 never got admitted to the facility. Interviews with two (2) out of four (4) residents who were able to communicate also confirmed they had never seen or heard of R1 living in the facility. Residents stated they receive excellent care and supervision residing in this facility and never had any issues with staff members not providing care needs on a timely manner. LPA also reviewed residents’ roster which revealed that R1 was never admitted and currently is not residing at this facility. LPA have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. LPA have therefore dismissed the complaint. Exit interview conducted. Copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Aug 28, 2025 · control 31-AS-20250823170952

Type of visit: Required - 1 Year

On 4/14/25 an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the Caregiver Josephine Espiritu, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. Shortly after the Administrator, Jeffrey Savella arrived and helped with staff/residents’ files and medications. During today's visit, LPA conducted a physical plant walk through, at approximately 9:45am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22. The following was observed: The facility is a single-story home and is licensed for capacity of six (6) residents, of which six (6) may be Non-Ambulatory and of which fire clearance for one (1) Bedridden. Facility also has a hospice waiver for six (6) residents. There are six (6) bedrooms, of which five (5) bedrooms are designated for residents’ use and one (1) bedroom #1 is designated for staff use only. All bedrooms observed to be appropriately furnished and have appropriate lighting. There are four (4) bathrooms in the facility of which three (3) are designated for residents’ use and one (1) for staff use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 10:10am to be 109°F. Extra towels and linens were readily available in the linen closet located in the hallway next to the entrance door. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. LPA observed facility alarms were present on all exit doors and all of the signals were functional. SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 10:55am they were tested and observed to be operational. The facility has two (2) fire extinguishers that were last purchased on 2/13/2025. Continue on LIC809-C KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, dish washer and sink. The kitchen appliances and fixtures were functional. LPA observed the kitchen area, there was sufficient stock of one week non-perishable foods and two days of perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. LPA observed that sharp objects were stored inside the kitchen cabinet, which was observed to be locked and inaccessible to residents in care. Extra emergency food was properly stored inside the pantry. The common areas which include dining and living room appeared clean and were properly furnished. Temperature was comfortable it was measured at 11:05am to be 74°F. No obstructions and or tripping hazards throughout the facility found. MEDICATION: LPA observed medications are centrally stored and locked inside the kitchen cabinet. First Aid kit was also available and stored inside the kitchen cabinet, inaccessible to residents in care. It was checked by the LPA to be complete with the new manual available with it. Facility operated with two (2) shifts and has three (3) staff for AM shift and three (3) awake caregivers for PM shift. COMMON AREAS: LPA observed living room and a dining room that appeared generally clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Facility has land line; LPA checked its operational. LAUNDRY ROOM: Laundry machines are located by the kitchen area and observed to be operational. LPA observed chemicals and detergents were stored and locked inside the cabinet located outside of the facility. LPA discussed the importance of keeping potentially dangerous items locked at all times. SURROUNDING GROUNDS: LPA observed sufficient yard space with fenced backyard. Appropriate outdoor furniture, with covered shaded area available for residents to rest and enjoy outside weather. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. Exit doors were unlocked and free of obstructions. The facility does not have a swimming pool or body of water. There is no garage in the property. FILE REVIEW: Between 11:15am to 12:30pm, LPA reviewed records and files of five (5) residents and four (4) staff/caregivers. A review of staff and resident records appeared to be complete. Resident’s files contain signed admission agreements and a medical assessment, and all other required documents/forms. Continue on LIC809-C A review of staff records indicates that all facility staff and who required caregiver background checks have received criminal record clearances. There are no residents with prohibited conditions residing at the facility. Facility provides activities to the residents in care, two out of five residents participate in Adult Day program. An emergency exit plan/sketch along with other posting requirements are posted on the wall by the entrance area. Medications Review: At approximately 12:35pm. LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. Facility also maintains Medical Administration Records (MAR). PRN medications have written orders from a physician. Potentially dangerous items are kept inaccessible to residents in care. LPA collected LIC500, LIC9020, copy of Liability Insurance Certificate. No citation issued during today’s visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Apr 14, 2025

Type of visit: POC

Licensing Program Analysts (LPA) Leslie Ngo-Castaneda met with facility licensee Jeffrey Savella for a Plan Of Correction (POC) visit. The purpose of the POC visit is to make sure deficiencies were corrected on reports issued on 8.7.2024. Entrance interview conducted. LPA toured the home and requested the following: -CCR 87465(d)(2) (d) and 87465(e), Incidental Medical and Dental Care Services: POC: Staff needs to be re-trained for medication dispensing and log. POC date 8.23.2024: POC cleared during LPA visit. -CCR 87506(b)(13), 87506(b)(15), 87506(b)(17)(A), 87506(b)(17)(B), 87506(b)(17) (c ) &, 87506(b)(17)(D) Resident Records: POC: Licensee needs to fill-in residents functional capability, appraisal, pre-admission, functional capability, mental condition, social factor POC date 8.23.2024: POC Cleared during LPA visit. -CCR 87456(a)(2), Evaluation of Suitability for Admission: POC: Admission agreement needs to be done when taking in a new resident. POC date 8.23.2024: POC Cleared during LPA visit. Continue to LIC 809-C - CCR 87457(c ), 87463(a), & 87457(c)(1) Pre-Admission Appraisal: POC: Pre-admission appraisal is needed when taking in new resident. POC date 8.23.2024: POC cleared during LPA visit. - CCR 87463(a) Reappraisal: POC: Re-appraisal are needed POC date 8.23.2024: POC cleared during LPA visit. -CCR 87467(a) Resident Participation in Decision making - POC: Prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. - POC date 8.23.2024: POC cleared during LPA visit. - HSC 1569.885 (c ), 1569.886(d), & 1569.885(a) Admission Agreements -Admission agreement is needed when admitting a new resident. -POC date 8.23.2024: POC cleared during LPA visit. -CCR 87507(l) 87507(a)(1)(A), 87507(a)(1)(B), 87507(b) 87507 (c ), 87507(d),87507(g), 87507(g)(3)(A)1, & 87464 (c ) Admission Agreements -Admission agreement is needed when admitting a new resident. -POC date 8.23.2024: POC cleared during LPA visit. Continue to LIC 809-C - CCR 87464(d) Basic Services - Pre-admission for basic services needs to be done when taking in a new resident. -POC date 8.23.2024: POC cleared during LPA visit. - CCR 87508(a)(3) Register of Residents - LIC 601 needs to be filled-in. - POC date 8.23.2024: POC cleared during LPA visit. - CCR 87608(a) Postural Support - Resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used. - POC date 8.23.2024: POC cleared during LPA visit. -CCR 87411(a)(11) Personnel Records/Staff Training - S3 needs health screening and TB test. -- POC date 8.23.2024: POC cleared during LPA visit. Exit interview conducted and copy of this report was printed and given.the state’s words, verbatim · CDSS document, Aug 23, 2024

Allegation investigated: Resident had to be hospitalized due to staff neglect

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegation. It was reported that Resident 1 (R1) was brought to the hospital on or around 10/29/22 for a bacterial infection and the presence of maggots to R1’s toes as a result of facility neglect. The initial visit to this investigation was made by LPA Evelin Rios on 11/02/22. The complaint was also referred to Investigations Branch (IB) on 11/02/22, and accepted as a full investigation, assigned to Investigator Brian Slatic. During the course of IB’s investigation interviews and record review were made. IB’s Slatic’s investigation consisted of the following: • On 11/04/22, IB conducted a review of R1’s needs and service history. R1 was admitted into facility 09/30/22. R1 was receiving medical treatment from Brandman’s Centers for Senior Care and Skirball Hospice. Wound care was being provided by Skirball Hospice. Hospice records reveal history of bacterial infection and pressure injuries. Unsubstantiated · On 11/15/22, Hospice record review conducted. IB’s review reveal that during R1’s stay at the facility, nursing visits were made on 10/07/22, 10/12/22, 10/14/22, 10/19/22, 10/24/22, 10/28/22, 10/31/22. Client was hospitalized on 10/29/22. · On 12/13/22, IB reviewed records from Bradman’s center, which reveal documentation of Bacterial infection prior to admission to facility. Records confirm wound care provided from 09/30/22 to 10/29/22. During Home Health Agency (HHA) visit on 10/29/22, maggots observed to R1’s toe. R1 was sent to the hospital as a result. IB’s review of records indicate that R1 continued to receive wound care services after their return from the hospital. · On 12/13/22, IB reviewed medical records from the hospital. Record review reveal R1 arrived at the hospital on 10/29/22, and was discharged back to the facility on 11/02/22. R1 was admitted at risk for rapid decompensation due to infectious symptoms and evidence of worsening bacterial infection. On 10/31/22, treating physician recommended for surgery. On 11/02/22, Social Worker (SW) confirms R1 continued to receive daily wound care, hospice care, and weekly visits from Bradman. SW denied the maggots were due to lack of care. · On 12/29/22, IB interviewed R1’s family who was not aware of any care concerns. · On 01/12/23, IB interviewed the facility administrator, Jeffery Savella, Staff 1 (S1) and Staff 2 (S2). According to the administrator, “staff are trained to observe for any obvious changes and then report to the home health nurse. As far as the administrator knows, they did not observe any such changes or issues with R1’s wound care”. Interviews with S1 and S2 confirms that they are live-in staff that helps assist with R1’s care. Both staff acknowledge R1 was receiving wound care, and they help assist the hospice nurse with the bathing and cleaning to R1, but did not see the presence of maggots to R1’s toe. Staff also indicated that their job is to visually observe for any changes between nursing visits. Based on the information obtained by IB, R1’s conditions were chronic and existed before admission to this facility. R1 was receiving daily wound care and treatment from home health and hospice. Facility staff’s duty is to observe for any changes with R1 and report to home health, which they reported to no significant level of activity. While there was a presence of maggots to the toe area of R1, the evidence does not support that it was a result of caregiver neglect. Therefore, the allegation of staff neglect is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Aug 7, 2024 · control 31-AS-20221102123557

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff Josephine Espiritu was explained the reason for the visit. At 1:00 PM Jeffrey Savella who is the licensee arrived and met with LPA, was explained the reason for the visit. At 11:37 AM, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 1/2/2024. During the visit the facility is at 74 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; one (1) bedridden; hospice waiver for six (6). Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked cabinet under the sink of the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away under the kitchen sink. Bedrooms: There were six (6) bedrooms designated for residents' and staff use. Room #2, room #3, room #5 and bedroom #6 are all private. Bedroom #4 is shared. Room #1 is for staff used. Residents bedroom are properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C Bathrooms: There are four (4) bathroom designated for residents' and staff use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 105.1 degrees Fahrenheit for bathroom #1 located in the hallway in between room #2 and room #3. Bathroom #2 is inside bedroom #4. Hot water temperature was measured at 105.8 degrees Fahrenheit. Bathroom #3 is located beside the laundry area that is only use for staff. Bathroom #4 is beside bedroom #5 is under renovation, it is lock, closed and non-operational. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. The garage detached. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet under the kitchen sink. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Office space is beside the kitchen. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. S3 missing TB test and health screening. Deficiency will be cited on LIC 809-D. Continue to LIC 809-C Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has NOT been logged in the medications log with proper documentation from the clients’ doctor. Staff last log medication was back on 8.5.2024 for all residents. Deficiency will be cited on LIC 809-D. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: LPA reviewed client’s files for current appraisal R1, R2, R3, R4 and R6, no appraisal was seen R1, R2, R3, R4 and R6, LIC 601, no functional capability R1, R2, R3, R4 and R6; no admission agreement for R5. Deficiency will be cited on LIC 809-D. Planned activities are offered. Facility is within CA code of Regulations Title 22 or Health and Safety Code. Deficiencies were found and cited on LIC 809-D, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Aug 7, 2024

The state marks this report as 39 pages; the online copy we transcribed has 18. You can request the full file from the county licensing office.