Inspection Reports for Safe Haven – Sunnyvale
859 South Wolfe Road, Sunnyvale, CA 94086, CA, 94086
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Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 2
May 12, 2025
Visit Reason
The inspection was an unannounced Required 1-Year Annual inspection conducted to evaluate the facility's compliance with licensing requirements.
Findings
The facility was generally clean and well-maintained with adequate food supplies, functioning safety equipment, and proper staff and resident records. However, deficiencies were found related to missing appraisal of resident needs and services plans for 3 of 6 residents and incorrect entries in centrally stored medication records for 3 of 5 residents.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| 3 of 6 residents did not have an appraisal of needs and services plan available to facility staff during an emergency. | Type B |
| For 3 of 5 residents, medication prescription names, prescription numbers, and date filled were not entered correctly in the Centrally Stored Medication Records. | Type B |
Report Facts
Residents without appraisal of needs and services plan: 3
Residents with incorrect medication record entries: 3
Staff personnel records reviewed: 5
Resident records reviewed: 5
Hot water temperature range (°F): 118.4-119.2
Facility capacity: 6
Facility census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jesley Quirimit | Caregiver | Met with Licensing Program Analyst during inspection and involved in plans of correction |
| Kiran Jain | Licensing Program Analyst | Conducted the inspection and signed the report |
| April Cowan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Original Licensing
Capacity: 6
Deficiencies: 0
Apr 24, 2024
Visit Reason
The inspection was a pre-licensing visit conducted to evaluate the facility for initial licensing approval.
Findings
The facility was observed to be clean, in good repair, and ready to be licensed. No issues were noted during the pre-licensing inspection, and all safety and emergency equipment were functioning properly.
Report Facts
Facility capacity: 6
Census: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Aileen Grimesey | Applicant | Met with Licensing Program Analyst during pre-licensing inspection |
| Manuel Monter | Licensing Program Analyst | Conducted the pre-licensing inspection |
Inspection Report
Original Licensing
Capacity: 6
Deficiencies: 0
Apr 10, 2024
Visit Reason
Initial licensing evaluation conducted via telephone call with the Community Care Licensing analyst to verify applicant and administrator understanding of Title 22 and facility operation requirements.
Findings
COMP II was successfully completed by the applicant and administrator, confirming understanding of licensing requirements including facility operation, admission policies, staffing, emergency preparedness, complaints reporting, and pre-licensing readiness.
Report Facts
Capacity: 6
Census: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Richard Grimesey | Administrator | Participant in COMP II telephone call and applicant/administrator |
| Alieen Poquiz | Owner | Participant in COMP II telephone call |
| Shannon Betker | Licensing Program Analyst | Analyst conducting COMP II telephone call |
| Jude De La Concepcion | Licensing Program Manager | Named in report header |
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