134604417-8-16-2023-08-AS-DPOL-CW3SJ5-20230927135434

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 134604417
Report Date: 08/16/2023
Date Signed: 08/16/2023 06:38:04 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
05/16/2023 and conducted by Evaluator Esther Miller

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230516124845

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: 108	DATE:	08/16/2023
		UNANNOUNCED	TIME BEGAN:	12:01 PM
MET WITH:	Gabriela "Gabby" Zamora, House Manager		TIME COMPLETED:	02:37 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not meet resident's needs.
Facility did not create a safe environment.
Staff did not treat resident with respect

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 May 16, 2023, it was alleged that staff did not meet resident’s need, specifically shower needs. It was also alleged that facility did not create a safe environment and staff did not treat residents with respect. The Department’s investigation consisted of review of facility records, outside source records, and interviews of facility staff and outside sources.

It was alleged that staff did not meet resident’s needs, specifically Resident 1 (R1)’s shower needs. Facility records indicated that R1 was admitted on May 1, 2023. Facility records indicated R1 needed

[Continued on LIC9099, 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-20230516124845

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

assistance with showers and was assigned showers every Tuesday and Saturday. Shower logs for May 2023, July 2023, and August 2023 indicated that R1 was showered about once a week but often refused. Records for June 2023 showed R1 self-showered, but staff interviews indicated R1 was assisted with showers and refused some days. Interview with residents who interacted with R1 indicated that R1 frequently refused showers. The allegation is found to be UNSUBSTANTIATED.

It was also alleged that facility did not create a safe environment. Specifically, it was alleged that Resident 2 (R2) hit Resident 3 (R3). Resident 4 (R4) witnessed the incident and confirmed that R4 did hit R3. R4 stated that staff were not present. R4 indicated that R3 normally did not have aggressive behavior. House Manager was aware of the incident and had staff create an incident report on March 7, 2023. House Manager spoke to R2 about their behavior and did not have another incident of aggressive behavior until August 2023. On August 3, 2023, staff witnessed R2 in an altercation with another resident. House Manager stated, and documented, that R2 was told that continued aggressive behavior would result in an eviction notice. Based on the evidence obtained, the allegation is found to be UNSUBSTANTIATED.

It was also alleged that staff did not treat resident with respect, specifically that staff laughed at R3. Interviews with R3 indicated that staff had not laughed at them or treated R3 in a disrespectful way. Based on the evidence obtained, the allegation is found to be UNSUBSTANTIATED.

Based on the evidence obtained, the allegations 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