Safe Haven Sunnyvale

Type of visit: POC

On 9/4/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Proof of Correction visit in regards to the deficiencies cited during the Post-Licensing visits conducted on 8/27/2026 and 8/28/2026. LPA Calandra was greeted by Francis Pequet, House Manager and explained the purpose of the visit. Proof of Clearance letters were printed and delivered to the Licensee during the visit. An exit interview was conducted and a copy of the report provided to the facility representative.the state’s words, verbatim · CDSS document, Sep 4, 2026

Type of visit: Post Licensing

On 8/28/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to complete the Post-Licensing visit. LPA Calandra was greeted by Francis Pequet, House Manager and explained the purpose of the visit. LPA toured the physical plant. LPA toured the physical plant. This is a 1-story building with 5 bedrooms, 2 bathrooms, a kitchen, living room, dining room, office, front and backyards. All bedrooms had the required furniture and sufficient lighting. The facility's bathrooms had anti-skid flooring and grab bars. No accessible bodies of water or hazards were observed. The facility's physical plant and window screens were in good repair/condition. The facility's fire extinguishers were last checked on 9/22/2025 and were observed to be fully charged. The facility's hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility's smoke alarms and carbon monoxide detectors were observed to be functioning properly. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility's first aid kit had all of the required items. All sharp objects, soap, detergents, and poisons were observed to be locked and in-accessible to persons in care. LPA reviewed 2 resident files. One resident file was missing the Physician's/Medical Assessment. A Type B citation was issued for this deficiency. In addition, during record review and tour of the physical plant , LPA Calandra observed that R1 and R3 have half bed rails but the Licensee does not have orders for half bed rails for R1 and R3 in their files. A Type B citation was issued for this deficiency. During his review of resident records, LPA Calandra observed that R4 is considered Bedridden per their Medical Assessment/Physician's report. This facility only has fire clearance for Non-Ambulatory residents and cannot accept individuals who are considered Bedridden per a Medical Assessment. A Type A citation was issued for this deficiency. Due to the seriousness of this violation, a Immediate $500 Civil Penalty was delivered on 8/28/2026. During file review, LPA Calandra noticed that R1 did not have a Pre-placement Appraisal or a Appraisal of Needs and Services. Type B citations were issued for these deficiencies. In addition, LPA Calandra observed that the facility did not have record of their last quarterly emergency drill. A Type B citation was issued for this deficiency. 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. Deficiencies are cited under California Code of Regulations(CCR) Title 22. Failure to correct said deficiencies by the Plan of Correction due date may result in Civil Penalties. An exit interview was conducted. A copy of the report along with Appeal Rights were provided to the facility representative.the state’s words, verbatim · CDSS document, Aug 28, 2026

Type of visit: Post Licensing

On 8/27/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Post-Licensing visit. LPA Calandra was greeted by Francis Pequet, House Manager and explained the purpose of the visit. LPA Calandra reviewed 3 resident files and 5 staff files. 1 out of 5 staff members reviewed did not have Tuberculosis exam results. A Type B citation was issued for this deficiency. In addition, during a review of staff files, LPA Calandra observed that S1 does not have fingerprint clearance. During the visit, LPA Calandra observed S1 working and assisting residents. According to House Manager, Francis Pequet, S1 has worked at the facility since August 4, 2026. During the visit, Co-Administrator Ryan Alejo spoke to S1 and LPA Calandra observed S1 leave the facility. Per a conversation with Ryan Alejo and the House Manager, Francis Poquet, S1 will not be working at the facility until they have obtained proper fingerprint clearance. A Type A citation was issued for this deficiency. In addition, an immediate $500 Civil Penalty($100 a day x 5 days) was issued as S1 is required to have a California Criminal Record Clearance or a Criminal Record Exemption. During the physical plant tour, LPA Calandra observed a bottle of All-purpose cleaner that was left in the backyard and was accessible to persons in care. A Type A citation was issued for this deficiency. During the visit, House Manager, Francis Pequet picked up the bottle and locked it under the Kitchen sink. Deficiencies are cited under California Code of Regulations(CCR) Title 22. Failure to correct said deficiencies by the Plan of Correction due date may result in Civil Penalties. This Post-Licensing visit will be completed at a later date. An exit interview was conducted and a copy of the report along with Appeal Rights were provided.the state’s words, verbatim · CDSS document, Aug 27, 2026

Type of visit: Prelicensing

On 7/17/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the pre-licensing inspection. LPA Calandra was greeted by Ryan Alejo, Representative of Applicant. LPA toured the physical plant. This is a 1-story building with 5 bedrooms, 2 bathrooms, a kitchen, living room, dining room, office, front and backyards. All bedrooms had the required furniture and sufficient lighting. The facility's bathrooms had anti-skid flooring and grab bars. No accessible bodies of water or hazards were observed. The facility's physical plant and window screens were in good repair/condition. The facility's fire extinguishers were last checked on 9/22/2025 and were observed to be fully charged. The facility's hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility's smoke alarms and carbon monoxide detectors were observed to be functioning properly. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility's first aid kit had all of the required items. All sharp objects, detergents, and poisons were observed to be locked and in-accessible. Resident and Staff files were not reviewed as no residents were in care at the time of the pre-licensing. The Applicant will not be handling cash resources for residents. No deficiencies cited during today's visit Immediate Licensure is recommended. An exit interview was conducted and COMP III presentation provided to Applicants. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 17, 2026

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: Interview Method: Telephone interview On 7/13/2026, applicant/administrator participated in COMP II. Identification of the applicant / administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant / administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jul 13, 2026