Sunny Orchard Place

Type of visit: Required - 1 Year

On 6/30/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Luisa Roman, Caregiver and explained the purpose of the visit. Ofelia Guanzon, Administrator arrived later during the visit. LPA toured the physical plant. This is a 1-story building with 7 bedrooms (6 for residents and 1 for staff), 2 and a half bathrooms, a kitchen, living room, dining room, office, garage, and front and backyards. All bedrooms had the required furniture and sufficient lighting. All bathrooms had the required grab bars and anti-skid flooring. No accessible bodies of water or hazards were observed. The facility's smoke alarms and Carbon monoxide detectors were observed to be in working order. The facility's fire extinguisher was last checked on April 22, 2026 and was 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 6 staff files. All were observed to be complete. During record review, LPA Calandra observed that the Licensee had no record of the 4 hours of required training on postural supports, hospice, and restricted health conditions. 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. During the visit, LPA Calandra collected the following document: -Liability Insurance LPA Calandra requested that the Licensee send a copy of their current LIC 500 by 7/7/2026. 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 and a copy of this report and appeal rights provided to the facility representative.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Required - 1 Year

On June 16, 2025, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Assistant Administrator (ADM), Ofelia Guanzon, and disclosed the purpose of the inspection. ADM informed the LPA that the facility had six (6) residents in care and (2) staff members present at the time. At 9:06 AM, the LPA initiated a walk-through of the facility, accompanied by the ADM. There were (6) bedrooms and (2½) bathrooms designated for residents' use. All (6) resident rooms were single occupancy. LPA inspected all (6) resident rooms and found them clean, well-lit, and equipped with the required furniture. Storage closets with incontinence supplies were observed in every room. LPA inspected (2½) bathrooms and found them clean, sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can, a shower chair, and non-slip flooring. The hot water temperature at the sink faucet measured 118.1°F in bathroom #1 and 118.2°F in bathroom #2. The hallway closets were observed to contain clean linens, hand gloves, paper napkins, and towels for residents’ use. LPA inspected the kitchen and found it clean, with no food preparation and cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a locked cabinet under the kitchen sink containing knives, sharp objects, detergents and cleaning supplies. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food or stored medications were noted. Continued on LIC809-C LPA inspected the dining area adjacent to the kitchen and found it clean. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair. Two (2) residents were observed sitting on the dining table, reading newspaper and eating snacks. LPA inspected the living room and observed it clean, with all furniture in good repair. There were sofa chairs, recliners, tables, a television, and a piano in the living room. LPA inspected the fire extinguisher mounted on the wall in the living room and found it fully charged, with the last service tag dated 04/30/2024. The ADM tested the smoke and carbon monoxide detector located in the garage in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit. LPA inspected the garage and observed a washer and a dryer, and storage cabinets. A office room was observed near the front of the facility. LPA toured the backyard area, found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. It had a set of a patio table, chairs, and shaded areas for resident use. No bodies of water were noted. LPA reviewed six (6) staff personnel records and five (5) resident records. The LPA observed that 5 of 5 residents had an Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. 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. LPA observed a locked centrally stored medication cabinet in the hallway next to the living room. Medications were organized in separate bins for each resident. Centrally Stored Medication Records were reviewed and found to be complete. 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 quarterly, with the most recent drill completed on 04/14/2025. The following updated forms are requested to be submitted to CCLD by 06/23/2025: Continued on LIC809-C · LIC 500: Personnel Report · LIC 308: Designation of Facility Responsibility · Certificate of Liability Insurance · Administrator Certificate(s) No deficiencies were cited during today's visit. An exit interview was conducted with the Assistant Administrator. A copy of this report was provided to the Assistant Administrator, Ofelia Guanzon, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, Jun 16, 2025

Type of visit: POC

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 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.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: POC

On February 13, 2025, at 12:15 PM, 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 (6) residents in care. The DSP accompanied the LPA during the inspection. Administrator, Ofelia Guanzon joined shortly after. On 01/10/2025, the LPA conducted a Case Management – Other inspection at the facility. During the inspection, the LPA observed two units will walls and doors constructed in the garage. The deficiency was issued, and the plan of correction was developed with the licensee. The Licensee will submit the evidence of building permit and fire clearance for the garage alteration. If neither is obtained, the Licensee will demolish (2) units from the garage and submit photographic evidence to CCLD by 01/17/2025. POC was due on 01/17/2025, but as of today (02/13/2025), the LPA has not received a POC from the licensee. On 01/17/2025, LPA emailed the licensee asking the licensee to email the facility sketch with the alteration / construction in the garage. LPA didn’t receive any email reply from the licensee. On 01/21/2025, LPA emailed the licensee again asking for the updated sketch of the garage and reminded licensee that the POC was due on 01/17/2025. Today (02/13/2025) at 12:30 PM, the LPA inspected the garage in the presence of the caregiver and observed the doors have been removed, but the walls are 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. LPA inspected wooden chest placed inside the area of these walls, under the electrical lamp and mirror. LPA observed personal federal tax return form for Staff (S1) in top drawer of the chest, prescribed medication bottles for S1, hair and other personal products in the second drawer, personal clothes in the third drawer of the chest. Continued on LIC809-C On 02/13/2025, LPA talked to the licensee, Theresa Carr on the phone and the licensee stated they would send the updated facility sketch with the additions/alterations/construction done in the garage by 02/17/2025. A civil penalty was assessed for $100 per day for the period of 01/18/2025 to 02/13/2025 totaling $2,700 for a violation regarding the alterations done in the garage and not submitting POC by the due date of 01/17/2025, see LIC421FC. The civil penalty will continue to accrue $100 per day until the deficiency is corrected. An exit interview was conducted, and Plan of Correction was reviewed with the Administrator. A copy of this report, civil penalty, and appeal rights were discussed and left with the Administrator, Ofelia Guanzon, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Feb 13, 2025

Allegation investigated: Caregiver hit resident on the thighs.

On January 10, 2025, at 12:40 PM Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Complaint Investigation visit. Upon arrival, the LPA was greeted by the DSP, Luisa Regala. The LPA disclosed the purpose of the inspection. The DSP informed the LPA that there were (6) residents in care. Regarding the allegation “Caregiver hit resident on the thighs”, the Reporting Party (RP) stated “On 11/22/2024 the resident reported to the complainant that caregiver Kanalle, last name unkonwn, has hit him on his thighs for the past 6 months while providing care to him. The resident stated to the RP, "Kanalle is always rough with me". LPA interviewed (3) Residents (R1-R3). R1 was observed to be in their private room. R1 stated that S1 was rough with them, and about a week ago, the facility corrected this by removing S1 as the primary caregiver. Continued on 9099-C Unsubstantiated R1 stated that care was good now and had no further complaints and nothing to share. R2 stated that they liked all the caregivers and showed a thumbs-up sign when asked about the quality of care provided. R3 was not able to provide anything about S1. LPA interviewed (3) staff members (S1, S2, and S3). S1 stated they had challenges when providing care to R1 due to their yelling. R1 was in pain when S1 wiped their back and was not rough. S1 stated that they reported to their manager that it was rough for R1 when they wiped their back and needed (2) caregivers to bathe R1 and for R1’s other care needs. S2 stated that R1 is scared to turn by themselves and R1 shouts when they turn them. It was R1’s behavior to shout. S2 stated that R1 was itchy, and sensitive to touch and yells staff was hurting them when they touched R1. The staff was gentle with R1 when R1 was in pain. S2 stated that S1 was now paired with other staff members when providing care to R1. LPA interviewed (1) family member (FM). FM stated they are aware of R1’s behavior and R1 would scream when someone would touch R1. R1 scratches themselves aggressively and that’s why R1 screams when staff touches R1. FM is working with a doctor to resolve R1’s excessive scratching. FM stated that the facility had made changes so that R1 was not alone with S1. FM was happy with the care provided to R1 at the facility and had no negative remarks. LPA observed R1 shouting in pain when S1 and S2 were in R1’s room to change R1’s diaper. LPA interviewed R1 after the diaper change and R1 stated they had no complaints and S1 didn’t provide direct care to R1, S1 was in the room assisting S2. LPA reviewed the facility record of the Plan of Action. S1 will not be with R1 alone for now. S1 was given Elder Abuse Training on 12/10/2024. The facility will check on R1 every day for any bruises or scratches. Based on LPA’s observations, interviews that were conducted, and record review(s), the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation(s) is found to be UNSUBSTANTIATED. No deficiencies were cited during today's visit. An exit interview was conducted. A copy of this report was left with the DSP, Luisa Regala, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, Jan 10, 2025 · control 26-AS-20241205094700

Type of visit: Case Management - Other

On January 10, 2025, at 12:40 PM, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Case Management – Other inspection 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 (6) residents in care. The DSP accompanied the LPA during the inspection. At 1:23 PM, LPA inspected the garage and observed two units will walls and doors constructed there. LPA reviewed the facility sketch and the sketch didn’t show two units in the garage. LPA talked to the Licensee over the phone and asked the Licensee for a building permit and fire clearance document for this construction/alteration to the garage. The Licensee stated they don’t have the building permit and the fire clearance document for the garage alterations. A deficiency is being cited based on LPA observations, interviews, and records review conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and the Plan of Correction was reviewed with the DSP. A copy of this report and appeal rights were discussed and left with the DSP, Luisa Regala, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jan 10, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(a) · Plan of correction due date: Jan 17, 2025

87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Based on observation, records review, and interview conducted, the licensee did not ensure to get permit/fire clearance for (1) garage alteration by constructing (2) units in the garage, which poses a potential health, safety or personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Jan 10, 2025

Plan of correction: The Licensee will submit the evidence of building permit or fire clearance for the garage alteration. If neither is obtained, the Licensee will demolish (2) units from the garage and submit photographic evidence to CCLD by 01/17/2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with staff S1, Victoria Regala, Administrative Designee. During the visit, LPA observed 6 residents and 2 staff. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. The front yard and backyard were inspected. There was no obstruction to block the walkways. While touring the garage, LPA observed two rooms inside the garage. LPA asked S1 if LPA could enter. S1 stated the staff inside, S2, was "napping". Inside the first room in the garage, LPA observed a black couch with a pillow and blanket. LPA observed S2's medication bottles on the dresser counter as well. S1 stated S2 naps in there because he/she is the night shift staff. LPA also inspected the other room in the garage, which Staff S3 was using, had a bed with pillows and a blanket. (Photographs were taken.) LPA interviewed Staff S2 and S3. Both staff interviewed stated they sleep in the garage and work the night shift from 10pm-7am. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 116 degrees F in both resident bathrooms. PAGE 1 OUT OF 2 Fire extinguisher was serviced in April 30, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on May 2024. LPA requested to review the drill conducted in 2023. S1 stated that information is in the Los Altos care home and the facility ADM would return by tomorrow. LPA reviewed facility records for 3 residents. While reviewing residents R1 and R2's file, LPA discovered both had empty pre-admission appraisal forms. LPA asked S1 if they had completed them. S1 stated they did not have the forms filled out for R1 and R2 pre-admission appraisal. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 residents. LPA reviewed 3 staff files. LPA requested to review staff training records. S1 stated the training records were in the Los Altos facility. S1 stated the training had been completed, but the records were not available. By the end of the visit, S1 was unable to provide copies of staff training or documents stating disaster drills had been conducted in 2023. Deficiencies are being cited during today's visit. This report was reviewed with staff S1, Victoria Regala and a copy of the signed report was provided. Appeal rights were provided. PAGE 2 OUT OF 2 END OF REPORT.the state’s words, verbatim · CDSS document, May 16, 2024