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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 134604417
Report Date: 08/24/2023
Date Signed: 08/24/2023 01:43:50 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
11/03/2022 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20221103085230
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: 103DATE:
08/24/2023
UNANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Gabriela Zamora, ManagerTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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9
Staff are not administering medication as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings. LPA was allowed entry by Gabriela Zamora, Manager. LPA identified herself and disclosed the purpose of the visit and elements of the findings with the Manager.

On November 3, 2022 it was alleged that Staff are not administering medication as prescribed. Records reviewed for medication administration shows staff administered medication when required.

This Department has investigated the allegation that staff are not administering medication as prescribed found that the preponderance of the evidence was not met; therefore, the allegation is deemed unsubstantiated. An exit interview was conducted and a copy of this report along with the Licensee Rights (LIC 9058) were provided to the Manager. Her signature on this form confirms receipt of the documents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
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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