<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 134604417
Report Date: 12/06/2023
Date Signed: 12/06/2023 02:07:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
12/05/2023 and conducted by Evaluator Alyssa Ramirez
COMPLAINT CONTROL NUMBER: 08-AS-20231205162201
FACILITY NAME:SONRISA VILLA INC.FACILITY NUMBER:
134604417
ADMINISTRATOR:OSCAR CHAVEZFACILITY TYPE:
740
ADDRESS:708 E. 5TH ST.TELEPHONE:
(760) 756-3285
CITY:HOLTVILLESTATE: CAZIP CODE:
92250
CAPACITY:175CENSUS: 101DATE:
12/06/2023
UNANNOUNCEDTIME BEGAN:
10:49 AM
MET WITH:Manager Gabriela ZamoraTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of supervision resulted in residents being absent without leave.

Licensee did not follow reporting requirements.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced complaint visit to follow up on the above allegations. LPA met with facility Manager Gabriela Zamora and reviewed basic elements of the complaint.

During today's visit, LPA reviewed records, interviewed staff and then delivered findings.

On 12/5/2023, it was alleged that facility has lack of supervision resulted in residents (R1 & R2) being absent without leave (AWOL) and Licensee did not follow reporting requirements.

[Continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
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 4
Control Number 08-AS-20231205162201
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SONRISA VILLA INC.
FACILITY NUMBER: 134604417
VISIT DATE: 12/06/2023
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
[Continued from 9099]

Interview with Staff 1 (S1) revealed that resident 1 (R1) & Resident (R2) often leave the facility to go out in the community unassisted. S1 reported witnessing R1 & R2 leave the facility on Friday 12/1/2023 and then left as their shift ended. S1 stated that upon returning to the facility the next day (12/2/2023) they noticed that R1 & R2 had not returned to the facility. S1 admitted that they did not call the police or notify the Manager of the missing residents, as required, and was not able to provide a reason for this. S1 said they searched the local area for R1 & R2 on Saturday (12/2/2023) and Sunday (12/3/2023). S1 admitted that no one reported to any outside agency about the incident.

Interview with Manager revealed that she does not work on the weekends and S1 is in charge on weekends. Manager reported that she is always available by phone and has instructed staff to notify her if there is an emergency, including missing residents. Manager stated that she has verbally told staff what to do in the event there is a resident missing. This includes search the facility grounds, immediately call her, search the local area and immediately call the police. Manager reported that she became aware of situation on Monday 12/4/2023 when she did not see R1 & R2 as she typically does. Manager asked staff about the whereabouts of R1 & R2 and she was notified that they had been missing since Friday. Manager immediately called the police to report residents missing, called responsible parties and searched the town. Manager admitted that she did not notify Community Care Licensing and did not submit an incident report until requested to do by Community Care Licensing.

Review of client records revealed that according to R1 and R2’s most recent physician’s reports they are unable to leave the facility unassisted.

Based on evidence obtained during visit, both allegations are substantiated. Deficiencies are cited on LIC 9099-D, per CCL Title 22 regulations. Plans of correction were jointly developed with Manager Zamora, and a paper copy of this report was provided along with Licensee Rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20231205162201
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SONRISA VILLA INC.
FACILITY NUMBER: 134604417
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2024
Section Cited
HSC
87211(a)(1)(D)
1
2
3
4
5
6
7
A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence........(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents,
1
2
3
4
5
6
7
Manager will provide training to staff about reporting requirements and wil submit proof of training to LPA Ramirez by POC due date.
8
9
10
11
12
13
14
 or unexplained absence of any resident.
Based on interviews and records review, the Licensee did not submit an incident report to the Department regarding AWOL of R1& R2. This poses an potential safety risk to 101 of 101 residents in care.
8
9
10
11
12
13
14
12/06/2023
Section Cited
HSC
87464(f)(1)(c)
1
2
3
4
5
6
7
Basic services shall at a minimum include: Care and supervision ... "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health,
1
2
3
4
5
6
7
Manager will create an absentee notification plan and provide training to staff about absentee notification plan. Manager will submit proof of training to LPA Ramirez by POC due date.
8
9
10
11
12
13
14
 safety, or welfare would be endangered. This requirement was not met as evidenced by: Based on interviews, R1 and R2 eloped due to facility staff’s lack of supervision. This posed an immediate safety risk to two residents in care.
8
9
10
11
12
13
14
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: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4