134604417-5-25-2023-08-AS-DPOL-CSBUWZ-20230530155735

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 134604417
Report Date: 05/25/2023
Date Signed: 05/25/2023 06:54:57 PM

Unfounded

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
04/26/2023 and conducted by Evaluator Esther Miller

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230426161745

FACILITY NAME:	SONRISA VILLA INC.		FACILITY NUMBER:	134604417
ADMINISTRATOR:	GUEVARA, ITZEL		FACILITY TYPE:	740
ADDRESS:	708 E. 5TH ST.		TELEPHONE:	(760) 756-3285
CITY:	HOLTVILLE	STATE: CA	ZIP CODE:	92250
CAPACITY:	175	CENSUS: 103	DATE:	05/25/2023
		UNANNOUNCED	TIME BEGAN:	10:31 AM
MET WITH:	Gabriela "Gabby" Zamora, House Manager		TIME COMPLETED:	10:51 AM

ALLEGATION(S):

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Staff did not treat resident with dignity.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced complaint investigation visit to the facility in order to deliver findings on the above allegation. LPA was granted entry to the facility by Gabriela "Gabby" Zamora, House Manager, after identifying herself and explaining the reason for the visit.

On April 26, 2023, it was alleged that staff did not treat resident with dignity, specifically when staff place resident’s food on wheelchair to eat. The Department’s investigation consisted of review of facility records and interviews of facility staff and residents.

Facility records indicate that Resident 1 (R1) was considered bedridden from time of admission. Facility records and LPA observations indicated that resident could communicate needs. Interview with R1 indicated that they were alert and oriented to person, place, time, and situation. R1 stated that they

[Continued on LIC9099-C, Page 1 of 2]

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230426161745

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: 05/25/2023

NARRATIVE

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[Continued from LIC9099, Page 2 of 2]

wanted the food on the wheelchair so that they could reach for it. R1 expressed that if a table was available, they would eat from the table. R1 did not feel that it was disrespectful to place their food on the wheelchair. House Manager stated that she had been attempting to procure a table from a local supplier. R1 did express that they wanted a television in their room.

On May 25, 2023, Administrator stated that a table was offered to R1 on May 9, 2023. R1 refused the table and requested that their wheelchair continue to be used to place items and food on. LPA spoke with R1 who confirmed that they refused the table. R1 stated did not care either way to have a table. LPA observed that a new television bought with R1's money had been placed on a dresser at the foot of their bed.

Based on the evidence obtained during the complaint investigation, the allegation that staff did not treat resident with dignity is found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with House Manager; a copy of this report and Licensee's Rights (LIC9058) were provided.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC9099 (FAS) - (06/04)

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