Atria Sunnyvale

Type of visit: Required - 1 Year

On 6/16/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Richard Pogue, Maintenance Director and explained the purpose of the visit. Areyda Felix, Assistant Executive Director and Kris Waluszko, Regional Vice President arrived later during the visit. LPA toured the physical plant. This is a 2-story building with Assisted Living on the first floor and Memory Care on the Second floor. In total there are 73 apartments on the first floor and 64 apartments on the second floor. All bedrooms had the required furniture and sufficient lighting. No accessible bodies of water or hazards were observed. All bathrooms had grab bars and anti-skid flooring. The facility's carbon monoxide detectors and smoke alarms were observed to be in working order. The facility's fire extinguishers were observed to be fully charged. The facility's first aid kit was observed to have all of the required items. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. All sharp objects, soap, detergents, and poisons were observed to be locked and in-accessible to persons in care. LPA reviewed 5 resident files and 5 staff files. All were observed to be complete. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA received a copy of the facility's liability insurance and requested a copy of the facility's LIC 500(Personnel Summary Report) be sent to the Department by 6/23/2026. No deficiencies cited during today's visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jun 16, 2026

Allegation investigated: - Staff billed resident for services not rendered

On 04/21/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding allegation received. LPA met with Chad Jones and explained the purpose of today's visit. During the course of the investigation, documentation was reviewed and interviews are conducted. Per interviews, the responsible party was billed for services that were not rendered in error as the resident was not at the facility from January 15, 2026 through February 10, 2026. The resident was admitted to the hospital on January 15, 2026 and never returned to the facility. The responsible party provided the facility with a 30 day notice to the facility on January 10, 2026. The responsible party received a notice of still owing the facility $2157 for extra services that were not part of the basic care plan, but the resident was not present to receive those services. It was discovered that there was a clerical error due to the previous administrator. When this error was found by the current administrator, they were able to "zero out" the owed balance, thus eliminating the amount owed so the responsible party does not owe the facility the balance as stated. The family did not pay that amount stated so no refund was needed to be issued. This allegations is unsubstantiated. Based on these observations, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. Report is reviewed with the administrator and a copy is provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 21, 2026 · control 26-AS-20260326120029

Type of visit: Case Management - Other

On January 8, 2026, Licensing Program Analyst (LPA) conducted a case management visit to follow-up on an incident report that was reported by facility. LPA met with the administrator and explained the purpose of today's visit. On December 19, 2025, the facility report an incident that happened on December 18, 2025 concerning resident #1 (R1) who reported not feeling well while being assisted to the bathroom by staff #1 (S1). Subsequently, R1 kneeled down on the carpet, facility called 911 and when the paramedics arrived, they proceed with CPR and they were told by R1's responsible party that R1 was not to be resuscitated. R1 was pronounced deceased. The facility also submitted a death report including R1's diagnosis but the immediate cause of death was not indicated During today's meeting, LPA requested for a copy of R1's death certificate and the administrator stated that R1's family member does not have a copy of the death certificate and the administrator will provide a copy to CCL when available. No deficiency is cited. This report is reviewed and discussed with the administrator. A copy is provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Required - 1 Year

On June 05, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Executive Director (ED), Flavio Silva, and disclosed the purpose of the inspection. The facility consisted of one building with two floors with a combination of assisted living on both floors and memory care (Life Guidance) on the first floor. The ED informed the LPA that the facility had 92 residents in care at the time, including 70 in Assisted Living and 22 in memory care. At 9:12 AM, LPA initiated a walk-through of the facility, accompanied by ED. LPA inspected randomly selected ten (10) resident rooms in Assisted Living and Memory Care units. The rooms were found to be clean, well-lit, and equipped with the required furniture. LPA inspected the private bathrooms in random rooms. The bathrooms contained soap, grab bars, towels, a trash can, and non-slip flooring. The hot water temperature at the sink faucets measured between 119.3°F and 129.6°F. “Oxygen in Use” signs were observed posted outside the residents’ room where oxygen was administered. At 9:38 AM, a pillbox containing medication was observed in the R2's room #110. LPA inspected the main kitchen and found it clean. The refrigerator, freezer, and pantry cabinets were checked, and there was a sufficient supply of fresh perishable food for two (2) days and nonperishable staples for seven (7) days. No expired food items were found. Open food items were wrapped and dated. The dining rooms in Assisted Living and Memory Care was inspected and were found to be clean, with all furniture in good repair. Continued on LIC809-C LPA inspected laundry stations on each floor and observed working washer and dryer units. Sharp objects, detergents, and chemicals were observed to be locked and inaccessible to persons in care. LPA inspected activity areas, library, game areas, lounges, and other commons areas and observed residents actively engaged in recreational programs and activities. All common areas were free from obstructions, and hallways were well-lit. LPA inspected the fire extinguishers mounted on the hallway walls in Assisted Living and Memory Care and found them fully charged, with the last service tag dated 01/03/2025. ED tested the carbon monoxide detector in the hallway in LPA’s presence, and it was found to be functional. LPA reviewed the Fire Prevention routine inspection report, conducted on 02/24/2025, by the Department of Public Safety Fire Prevention & Hazardous Materials Certified Unified Program Agency, City of Sunnyvale. LPA toured the outside courtyard and patio areas and found passageways in good condition, free of obstructions, and without any blocking or tripping hazards. These areas had patio tables, chairs, and umbrellas for residents’ use. Delayed egress was observed on emergency exits. No accessible bodies of water or hazards were observed. LPA observed locked centrally stored medication carts in the Assisted Living and Memory Care units. Medications were organized separately for each resident. Narcotics were locked. All medication bottles and bubble packs were properly labeled. At 11:16 AM, Centrally Stored Medication Records were reviewed, medication count check was performed. LPA observed that the medication counts for 3 medications for 1 of 5 residents was found to be inaccurate and one less medication was administered to R1 for those 3 medications. LPA reviewed six (6) staff personnel records and five (5) resident records. The LPA observed that 5 of 5 residents had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. At 11:48 AM, The LPA observed that 3 of 5 residents did not have Safeguards for property/valuables inventory filed, dated, and signed. R2's LIC602 Physician's report stated that R2 had MCI and didn't mention that R2 can manage medication on their own (a pill box with medication was observed in R2's room). LPA observed that 6 of 6 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 6 of 6 staff members were associated with the facility. Continued on LIC 809-C LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted monthly, with the most recent drill completed on 05/12/2025. The following updated forms are requested to be submitted to CCLD by 06/12/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Executive Director. A copy of this report and appeal rights were discussed and provided to the Executive Director, Flavio Silva, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jun 5, 2025

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

On April 02, 2025, at 10:30 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Case Management – Incident visit regarding a death report for Resident (R1) that was received by the department on March 25, 2025. Upon arrival, the LPA was greeted by the Executive Director (ED), Flavio Silva. The LPA disclosed the purpose of the visit. The ED informed the LPA that the total facility census was 88. According to R1’s Death Report, R1 had a fall at the facility on 03-18-2025 and was transported to the hospital, but the Licensing department had not received an Unusual Incident Report for R1’s fall and subsequent admission to the hospital. ED provided a copy of the Unusual Incident Report to the LPA for R1’s fall on 03-18-2025 and a copy of the fax transmittal page that showed the Unusual Incident Report was successfully faxed to the Licensing department on 03-18-2025 at 4:01 PM. ED stated that R1 had a fall on 03-18-2025 and a caregiver found R1 on the floor inside R1’s room in front of a chair. Care staff asked R1 if they could get up. R1 stated that they could not get up and said they were in pain. 911 was called and R1 was transported to the hospital. R1’s family and primary care physician (PCP) were notified. ED further stated that R1 was not necessarily a fall risk, and prior to the fall on 03-18-2025, R1 had been falling on and off. However, there was never a need to call 911 since R1 had been able to get up and had not reported any pain. Continued on LIC809-C ED stated that they spoke with R1’s family around 03-21-2025 or 03-22-2025. R1’s family told the ED that R1 was agitated in the hospital, screaming in pain, and the family was planning to place R1 on hospice. R1’s family called the ED on 03-24-2025 to share the news of R1’s passing and asked when they could empty R1’s room. There was no complaint from R1’s family about anything. The ED further stated that they did not have R1’s hospital discharge notes, as R1 did not return to the facility after being discharged from the hospital. LPA reviewed R’s charting notes. On 01-24-2025 R1 had a fall in the hallway. R1 stated that they missed a step and fell down. R1 stated they didn’t hit their head nor were in pain. Care staff assisted R1 to stand up. On 03-11-2025, R1 fell from sitting on their walker while having lunch in the dining room. R1 stated they were ok, landed on their bottom, and didn’t hit their head. Care staff assisted R1 to sit back on the chair. R1’s family and PCP were notified. LPA reviewed R1’s LIC602 Physician’s Assessment Report, dated 10/19/2022, which stated that R1 was non-ambulatory and was able to independently transfer to and from the bed. LPA reviewed R1’s Functional Capabilities document, dated 02-22-2025, which stated that R1 used a walker and/or wheelchair. No deficiencies were cited during today's visit. An exit interview was conducted with the Executive Director. A copy of this report was provided to the Executive Director, Flavio Silva, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, Apr 2, 2025

Type of visit: Case Management - Incident

On January 02, 2025, at 10:40 AM Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Case Management – Incident visit regarding (3) separate incidents that occurred on 12/23/2024, 12/22/2024, and 11/27/2024. Upon arrival, the LPA was greeted by the Executive Director (ED), Flavio Silva. The LPA disclosed the purpose of the inspection. 1) For incident #1, happened on 12/23/2024, resident (R1) was given wrong medication and resident (R2) was not given medication. On 01/02/2025, LPA Jain interviewed residents (R1 and R2), two staff members Executive Director (ED) and Resident Services Director (RSD). LPA Jain interviewed R1. R1 stated on 12/23/2024 morning, a nurse came to their room, didn’t turn on the lights, and gave the medication to R1. R1 ate the medication. R1 stated that their regular nurse (S1) came back after some time with medication again. R1 told the nurse they already ate it. The nurse told R1 nothing is marked on the computer and went out of the room. R1 picked the empty cup from the garbage and saw #241 written on it, which was not R1’s room number and went to ED’s office and told ED what happened. ED told R1 that they would investigate. R1 further stated that the nurse who gave the medication to R1 didn’t mark the medication given to R1 and luckily the medications were same and R1 didn’t feel any side effects of the medication given. R1 told their family members about this incident. LPA Jain interviewed R2. R2 stated that they have no idea if medication was not given to them on 12/23/2024 morning. R2 said nothing happened and its fine if they missed the medication. LPA Jain interviewed ED. ED stated that Incident happened on 12/23/2024 morning. RSD was working as med tech during the overnight shift from 12/22/2024 8:30 PM to 12/23/2024 7:30 AM. On 12/23/2024, around 9:40 AM, R1 came to ED’s room and said they took the medicine from room #241 while holding the cup. Continued on LIC809-C R1 stated to ED a different MedTech came in the morning and gave them the medication from this cup. R1 stated to ED when they got up around 7 AM, they didn’t recognize the med tech and went to garbage to pick up the medicine cup. The cup said room #241 and not room #229. ED asked R1 to stay in their office and asked R1 if they were doing OK. ED checked MARS to noticed both the resident’s medications were given. ED noticed the medication were the same but with different strength. ED asked the caregivers to monitor resident for any change of condition. ED asked MedTech to send a note to the R1’s doctor stating which medication were given to the resident. ED stated that resident (R2) never got their medication. Shift changed at 7 AM. RSD told med tech that R2 needs their medication. Med tech saw a cup in medical cart with room #229 (R1’s) medication inside. Med tech didn’t not give those medications to R2. ED contacted the family of R2 and told them that R2 missed the medication as Med tech didn’t give them medication to the resident. A note was sent to R2’s doctor on the missed medications. ED stated that staff member S1 is on vacation and will be back on 01/26/2025. LPA Jain interviewed RSD. RSD stated they started med pass around 5 AM on 12/23/2024. They were multitasking, while preparing medicines for the resident (R2), they were answering (2) phone calls and in between had to pause med pass to open the front door of the facility. When they came back to R2’s room, instead of giving medicine to R2, they moved to next person who is R1 and inadvertently gave the wrong medication cup to R1. Didn’t know wrong medication was given to R1 until R1 brought it up. On 01/02/2025, LPA Jain reviewed the Medication Administration Record (MAR) for R1 and R2. Records indicated that on 12/23/2024, medications were administered to both R1 and R2 in the morning. Based on interview with ED and the incident report submitted to the licensing department, RSD missed to give medication to R2. LPA Jain reviewed the note sent to R2 doctor indicating that R2 missed the morning medication. 2) For incident #2, happened on 12/22/2024, resident (R3) was found with two large bruises on the back of his right thigh and large bruise on his right hand. The origin of the bruises was unknown. LPA Jain interviewed ED. ED stated R3 is in memory care and is a fall risk. R3 walks by themselves in the hallway. Doesn’t use a walker. R3 uses a walker only when staff is nearby. R3 gets up from their bed and walks out of the room. Memory care has no bed alarms, no sensors, and no mat alerts. Care staff monitors the residents constantly. Continued on LIC-809C If resident is constantly falling, facility request family to provide a private companion for the resident. If falls can’t be controlled, then facility asks the family to move the resident to another facility. R3 is currently at the hospital due to weakness. If R3 is diagnosed of puree diet, then R3 had to go to skilled nursing home and then gets revaluated before being accepted back at the facility. LPA Jain obtained and reviewed R3’s doctor’s note received by the facility after 12/22/2024 fall, Physician’s report, Resident functional needs and service plan, preplacement appraisal information. 3) For incident #3, happened on 11/27/2024, resident (R4) had multiple fall incidents, the incident reports for these incidents were sent by the facility and received by the licensing department on 12/13/2024. ED stated the fax was sent on 11/27/2024 to the licensing department and showed the fax confirmation page for the IR sent on 11/27/2024. ED stated that they didn't receive a confirmation page from their staff and hence ED asked their staff to refax the IR on 12/13/2024. LPA Jain collected the fax confirmation page for 11/27/2024 incident that was originally sent on 11/27/2024. A deficiency was cited based on LPA observations, record reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Executive Director. A copy of this report and appeal rights were discussed and left with the Executive Director, Flavio Silva, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jan 2, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Jan 3, 2025

87465 Incidental Medical and Dental Care (c)(2) Once ordered by the physician the medication is given according to the physician's directions. This was not met as evidence by: Based on observation, interviews, and records review the licensee did not ensure R1 was given the right medication and dosage on 12/23/2024 morning. R2 was not given medication on 12/23/2024 morning and MAR shows R2 was given the medication.the state’s words, verbatim · CDSS document, Jan 2, 2025

Plan of correction: The Executive Director will develop a plan to ensure correct medications ordered by physician are always given to the residents. Executive Director will provide a copy of the plan to CCLD by 01/03/2025.

Allegation investigated: -Staff are not returning authorized representative's calls -Staff did not seek timely medical care for resident

On December 10, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver the findings of the complaint investigation. LPA met with Executive Director, Flavio Silva and explained the purpose of today's visit. Regarding to the allegation of- staff are not returning authorized representative's call, the reporting party stated that the responsible party called the facility to ask questions and the facility was not returning calls. Based on interviews, facility staff stated that they have contacted and left messages for the reporting party after an incident that happened to resident #1 (R1). Based on documentation provided by the facility, it indicated that the facility called, texted and emailed R1's responsible party. After the investigation, this allegation is deemed to be unsubstantiated. (continue 9099C) Unsubstantiated Regarding to the allegation of - staff did not seek timely medical care for resident, the reporting party stated that the responsible party wanted to know why it took so long to do Cardio Pulmonary Resuscitation (CPR) on R1 and delayed in reviving R1. According to staff #1 (S1), he/she was called by Staff #2(S2) to the dining room because S2 observed R1 was not well. When S1 arrived in the dining room, S1 also noticed that R1 had a change in health condition and proceeded with calling 911 and while speaking to the 911 operator, S1 observed that R1 was no longer breathing, therefore, S1 started performing CRP as instructed by the 911 operator. LPA interviewed the reporting party who stated that they were told by the hospital that there was a delay in transferring R1 to the hospital but there was no documentation from the hospital indicating that as well as the facility delayed with performing CPR. LPA interviewed the administrator who stated that S1 performed CPR immediate after it was instructed by the 911 operator. After the investigation, this allegation is deemed to be unsubstantiated as there is no proof that there is a delay with staff performing CPR. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. This report is reviewed and discussed with Executive Director and a copy is provided.the state’s words, verbatim · CDSS document, Dec 10, 2024 · control 26-AS-20230911114451

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit and met with Administrator (ADM) Flavio Silva and stated the purpose of today's visit. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. LPA Rai observed the fridge temperature at 40 degrees F and the freezer temperature at 0 degrees F. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the resident bedrooms. At random, LPA Rai observed 5 out of 5 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap and paper towels. The water temperature in the bathroom sinks ranged from 118.9 degrees F - 119.8 degrees F. Fire extinguisher was observed and inspected on 01/31/2024. Facility smoke detectors and carbon monoxide detectors were inspected by third party vendor on 01/31/2024 and are in working condition. The last disaster drill was conducted on 05/19/2024. LPA Rai reviewed facility records for 5 staff and 5 residents. LPA Rai reviewed resident medications and central stored medication records. No deficiencies were cited per California Code of Regulations, Title 22. Technical Violation was provided during visit. This report was reviewed with Administrator, Flavio Silva and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 25, 2024

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff caused an injury to a resident while in care due to abuse

On 2/29/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegation. LPA met with Resident Services Director Cathy Platon.. LPA explained the purpose of the visit. Regarding the allegation of staff caused an injury to a resident while in care due to abuse, the Reporting Party (RP) stated that the suspected abuser (SA) moved the resident (R1) from the wheelchair to the bed. In doing so, the SA grabbed the resident with enough pressure that it left a bruise on the client. During the course of the investigation, LPA Ng was able to interview R1 and mentioned that they don’t remember who the caregiver was who helped with the transfer. R1 also felt that was not doing it on purpose. R1 still felt safe in the facility. A staff member (S1) who was on duty at this time, mentioned that they did not believe there was an abuse by staff. Three other staff members who were interviewed has denied seeing any resident being abused in the facility. Another staff, S2, also mentioned that a retraining would be conducted by home health agency nurse to train the caregivers the proper way to assist residents getting up safely. Unsubstantiated Based on records review, a report was submitted which stated that, it was determined that there were no signs of abuse and that R1 felt safe in the facility. The facility also conducted in-service training to train the caregivers the proper way for resident transfers. Based on interviews & records review, the department has determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Feb 29, 2024 · control 26-AS-20210817170716