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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 134604417
Report Date: 10/02/2024
Date Signed: 10/03/2024 12:50:48 PM

Substantiated


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
09/26/2024 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20240926094605
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: 100DATE:
10/02/2024
UNANNOUNCEDTIME BEGAN:
11:16 AM
MET WITH:Manager, Gabriela ZamoraTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility staff interfered with resident receiving packages
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted a complaint investigation visit. LPA met with Manager, Gabriela Zamora and discussed the allegation listed above.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff and residents. It was alleged facility staff interfered with resident receiving packages. It was reported Resident #1 (R1) ordered some items online in February 2024 and September 2024 that were not delivered promptly. Records reviewed regarding package delivery to the facility was confirmed and signed by staff for both occasions. The manager's interview revealed the staff working the front desk, signs for the package then it's placed in designated areas located behind the front desk. Residents will either come to the front desk to retrieve the package or staff will deliver the package to the resident. A package was delivered on 02/12/24 for R1 but not received by R1. According to R1, the package contained medications and they had to reorder and pay again for the medications. Staff interviews revealed they were not aware of that package. Continued on an LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
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-20240926094605
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: 10/02/2024
NARRATIVE
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On 09/19/24, records revealed another package was delivered to R1 and signed by facility staff as received. Staff interviews confirmed they sign for the packages for residents and once it slows down they deliver the package to the resident or the resident stops by the front desk to obtain the package. Staff were not aware of the whereabouts of the package delivered on 09/19/24. R1's interview revealed asking the front desk staff on 09/19/24 for the package, once receiving the delivery message and again each day until delivered. Staff denied being asked for the package on any of the days. The manager's interview stated after talking with staff it was discovered the package was located behind a large air conditioning unit, which was hard to see located at the front desk. On 09/25/24, the package was accidentally delivered to another resident with the same first name. The other resident opened the package and realized it was not their package and it was returned to the front desk. Staff observed the package was opened and used to tape to seal the package back up. On 09/25/24, R1 sent an email to the facility regarding the package still not being delivered, then two (2) hours later that same day, staff delivered R1's package to them. The regulation states the resident has the right to receive unopened correspondence in a prompt manner. Even though there was an issue with the facility providing the package to the incorrect resident. R1 received an opened correspondence seven (7) days late, which was not in a prompt manner.

Based on interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation was found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Manager, Gabriela Zamora whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20240926094605
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2024
Section Cited
CCR
87468.1(a)(15)
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Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To send and receive unopened correspondence in a prompt manner. This requirement is not met as evidenced by:
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The Manager stated they will be using a package delivery form and have residents sign once they obtain their package. The Manager also stated she will conduct in-service training on the form and ensure packages are delivered unopened and in a prompt manner. Manager will submit proof of
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Based on interviews and record review, the licensee did not ensure 1 out of 100 [R1] resident received their correspondence unopened and in a prompt manner, which posed a potential Personal Rights risk to residents in care.
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training. POC due date 10/30/24.
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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: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
09/26/2024 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20240926094605

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: 100DATE:
10/02/2024
UNANNOUNCEDTIME BEGAN:
11:16 AM
MET WITH:Manager, Gabriela ZamoraTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility does not have a qualified administrator

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted a complaint investigation visit. LPA met with Manager, Gabriela Zamora and discussed the allegation listed above.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff and residents. It was alleged the facility does not have a qualified administrator. It was reported there is a manager in charge but does not have an administrator certificate. The manager is not required to have a active administrator certificate. The facility has an assigned qualified administrator with a current active certificate dated 02/18/23 - 02/18/25. A review of the administrator's records confirmed proof of qualification. The facility's manager is the designated responsible person for the facility when the administrator is unavailable. The manager confirmed the administrator is at the facility approximately twice a week. However, the manager is at the facility daily to ensure the residents needs are met. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Manager, Gabriela Zamora whose signature below confirms receipt of these rights.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4