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Complaint Investigation

Sunnyvale Post-acute Center

September 11, 2025 · Sunnyvale, CA · 1291 S Bernardo Avenue
Citations 3
CMS Rating 1/5
Beds 99
Provider ID 555792
Healthcare Facility
Sunnyvale Post-acute Center
Sunnyvale, CA  ·  View full profile →
Inspection Summary

SUNNYVALE POST-ACUTE CENTER in SUNNYVALE, CA — inspection on September 11, 2025.

Found 3 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

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Inspection Findings

FF0609
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Potential for More Than Minimal Harm

During an interview with Resident 2 on 7/10/25 at 2:15 p.m., Resident 2 stated that on 6/25/25 he reported the alleged rough handling of Resident 1 to the woman medication charge nurse. Resident 2 further stated he was asked what exactly happened.Review of Resident 2's clinical records he was admitted to the facility on [DATE] with diagnosis including post-traumatic stress disorder (a mental health condition that develops after experiencing or witnessing a traumatic event). Resident 2's minimum data set (MDS, an assessment tool) dated 5/5/25 indicated his brief interview for mental status (BIMS, an assessment tool used by facilities to screen and identify memory, orientation, and judgement status of the resident) score was 15 (score of 15 indicates cognition [ability to remember, judge and use reason] is intact).

During an interview on 7/17/25 at 10:56 a.m., with Certified Nursing Assistant B (CNA B), CNA B acknowledged that he was the CNA assigned for Resident 1 at night shift on 6/25/25. CNA B stated that he did not roughly handle Resident 1 during incontinent brief change. CNA B denied that Resident 2, the roommate of Resident 1, notified the charge nurse about a CNA roughly handling Resident 1 during incontinent brief change.

During an interview on 7/23/25 at 2:25 p.m., with Licensed Vocational Nurse A (LVN A), LVN A stated that she was the full-time charge nurse working night shift for Resident 1 and did not observe or there was no report of any suspicious of abuse to Resident 1 on 6/25/25. LVN A denied that Resident 2 the roommate of Resident 1 notified her about a CNA that roughly handle Resident 1 during incontinent brief change.

During an interview with the DON on 8/13/25 @ 12:27 p.m., the DON stated that the allegation of abuse was not brought to her attention by LVN A and CNA B that was interviewed by CDPH on 7/17/25 and 7/23/25.

The DON further stated if they were notified by anyone other than California Department of Public Health (CDPH) they would have reported it to CDPH, Ombudsman (long term care ombudsman. representatives that assist residents in the long term care facilities with issues related to day to day care, health and safety concerns) and Police.During a review of the facility's policy and procedure (P&P) titled, Abuse, Neglect, Exploitation, or Misappropriation-Reporting and Investigating, dated 2001.

The P&P indicated, .1. If Resident Abuse, Neglect, Exploitation, misappropriation of resident property, or injury of unknown source is suspected, the suspicion must be reported immediately to the administrator and to other officials according to state law.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/11/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Sunnyvale Post-Acute Center

1291 S Bernardo Avenue Sunnyvale, CA 94087

SUMMARY STATEMENT OF DEFICIENCIES

During an interview and concurrent record review with Minimum Data Set Coordinator (MDSC) on 7/10/25, at 2:53 p.m., MDSC reviewed Resident 1's MDS, dated [DATE], and confirmed section B0200 was coded 0, indicating Resident 1's ability to hear was adequate. MDSC confirmed section B0200 should have been coded 3, to indicate Resident 1's highly impaired hearing and with diagnosis of bilateral sensorineural hearing loss.The Centers for Medicare & Medicaid Services (CMS) Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual (RAI Manual, MDS coding instructions), dated 10/2024, indicated for section B0200, Code 3, for highly impaired hearing.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/11/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Sunnyvale Post-Acute Center

1291 S Bernardo Avenue Sunnyvale, CA 94087

SUMMARY STATEMENT OF DEFICIENCIES

Based on observation, interview, and record review, the facility failed to ensure garbage was disposed properly when one of three facility garbage was overflowing.

This failure had the potential to result in the spread of disease from vermin infestation and unsanitary environment for the residents.Findings:During an observation on 7/10/25 at 12:07 p.m., at the back of the parking area, there was an uncovered, blue bin with overflowing garbage positioned at the back door of the facility.

During an interview on 7/10/25 at 1:58 p.m. with the infection control preventionist (IP), the IP verified that the garbage was overflowing from the blue bin and not covered.

The IP mentioned that the garbage bin must be closed and should not be overflowing.A review of undated facility's policy and procedure (P&P) titled Food- Related Garbage and Rubbish Disposal indicated that All garbage and rubbish containers shall be provided with tight-fitting lids or covers and must be kept covered when stored or not in continuous use.

Facility ID:

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in SUNNYVALE, CA, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from SUNNYVALE POST-ACUTE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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