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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 134604417
Report Date: 02/18/2022
Date Signed: 02/18/2022 09:08:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/18/2022 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20220218115016
FACILITY NAME:SONRISA VILLA INC.FACILITY NUMBER:
134604417
ADMINISTRATOR:GUEVARA, ITZELFACILITY TYPE:
740
ADDRESS:708 E. 5TH ST.TELEPHONE:
(760) 356-1262
CITY:HOLTVILLESTATE: CAZIP CODE:
92250
CAPACITY:175CENSUS: 83DATE:
02/18/2022
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Itzel Guevara and Care Coordinator Gabriela ZamoraTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Licensee chained and locked facility front door, against fire clearance.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen and Licensing Program Manager (LPM) Simon Jacob conducted an unannounced Complaint visit to investigate the above allegation. LPA and LPM were welcomed by, identified themselves to, and discussed the purpose of the visit with Administrator Itzel Guevara and Care Coordinator Gabriela Zamora.

The Department's investigation consisted of touring the facility, reviewing pertinent facility records and photographic evidence, and interviewing staff and third party sources. The evidence revealed that during the overnight shift starting on February 17, 2022 and ending on February 18, 2022, facility caregivers Staff #1 (S1) and Staff #2 (S2) [see LIC 811 Confidential Names List for a description of S1 and S2] chained and padlocked the facility's front door, while they left the lobby area to provide resident care. CCLD and the facility's fire clearance prohibit Licensee from locking the facility's exterior door fire exits. [CONTINUED ON LIC 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 08-AS-20220218115016
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SONRISA VILLA INC.
FACILITY NUMBER: 134604417
VISIT DATE: 02/18/2022
NARRATIVE
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[CONTINUED FROM LIC 9099]

Based on records reviewed and interviews, a preponderance of evidence exists, and the complaint allegation is substantiated. A deficiency was cited per California Code of Regulations, Title 22 [refer to the attached LIC 9099-D], and an immediate civil penalty of $500 was assessed [refer to the attached LIC 421IM (07/17)] for fire clearance violation.

A Plan of Correction was jointly developed with Guevara and Zamora. An exit interview was conducted with the administrator, to whom a copy of this report, the Confidential Names List (LIC 811), and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20220218115016
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SONRISA VILLA INC.
FACILITY NUMBER: 134604417
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
03/18/2022
Section Cited
CCR
87203
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87203 Fire Safety: "All facilities shall be maintained in conformity with the regulations adopted by the State Fire Mashall for the protection of life and property against fire..." This requirement was not met as evidenced by:
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By time of CCLD's visit, Licensee had removed chain and padlock from the front door and completed written corrective counseling with S1 and S2, removing the immediate safety threat. Licensee shall arrange retraining for remaining staff on fire safety requirements, taught by a third-party source, and submit training sign-in sheet(s) to LPA by the POC due date.
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Based on photographic evidence, records, and interviews, Licensee did not maintain the facility in conformity with fire regulations, which posed an immediate safety risk to 83 of 83 residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3