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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 134604417
Report Date: 08/16/2023
Date Signed: 08/16/2023 06:30:22 PM

Unsubstantiated


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
07/20/2023 and conducted by Evaluator Esther Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230720153336
FACILITY NAME:SONRISA VILLA INC.FACILITY NUMBER:
134604417
ADMINISTRATOR:GUEVARA, ITZELFACILITY TYPE:
740
ADDRESS:708 E. 5TH ST.TELEPHONE:
(760) 756-3285
CITY:HOLTVILLESTATE: CAZIP CODE:
92250
CAPACITY:175CENSUS: 108DATE:
08/16/2023
UNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Gabriela "Gabby" Zamora, House ManagerTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Resident did not receive medication as prescribed.
Facility did not arrange medical care for resident.
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 allegations. LPA was granted entry to the facility by Gabriela "Gabby" Zamora, House Manager, after identifying herself and explaining the reason for the visit.

On July 20, 2023, it was alleged that resident did not receive medication as prescribed and facility did not arrange medical care for resident, specifically for Resident 1 (R1). The Department’s investigation consisted of review of facility records, outside source records, and interviews of facility staff and outside sources.

Facility records for R1 had a completed Medication Administration Log (MAR) for January 2023 to June 2023. Staff interviews and initials on MAR indicated R1 would refuse evening and bedtime medications. Outside source 1 (OS1) interview confirmed that medical personnel determined that R1 was not consistently taking

[Continued on LIC9099-C, Page 1 of 2]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
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 2
Control Number 08-AS-20230720153336
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: 08/16/2023
NARRATIVE
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medications based on their vital signs. Outside source 2 (OS2) interview also indicated that R1 had a history of refusing medication in different medical and care settings.

It was also alleged that facility did not arrange medical care for resident. OS1 and OS2 confirmed that R1 had a history and pattern of refusing care, including seeing medical professionals. A psychiatrist not employed by the facility provided care to many residents at the facility, including R1. MAR showed that R1 was prescribed medications by a nurse practitioner and a psychiatrist around January 2023, indicating that R1 had met with medical professionals.

Based on the evidence obtained during the complaint investigation, the allegations that resident did not receive medication as prescribed and facility did not arrange medical care for resident is/are found to be UNSUBSTANTIATED, meaning that although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with House Manager; a copy of this report and Licensee's Rights (LIC9058) were provided.

















[Continued from LIC9099, Page 2 of 2]
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2