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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134604417
Report Date: 10/02/2024
Date Signed: 10/03/2024 12:49:10 PM

Document Has Been Signed on 10/03/2024 12:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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
ADMINISTRATOR/
DIRECTOR:
OSCAR CHAVEZFACILITY TYPE:
740
ADDRESS:708 E. 5TH ST.TELEPHONE:
(760) 756-3285
CITY:HOLTVILLESTATE: CAZIP CODE:
92250
CAPACITY: 175CENSUS: 103DATE:
10/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Manager, Gabriela ZamoraTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Incident visit. LPA met with Manager, Gabriela Zamora and discussed the purpose of the visit.

On 09/30/24, the facility self reported an incident involving Resident #1 (R1). The Incident Report stated a on 09/26/24, a resident alerted facility staff at approximately 10:30am that R1 was walking in the middle of the road. At approximately 10:40am staff went to search for R1 but R1 was gone. R1 returned to the facility at approximately 2pm with no injuries. The Manager explained R1 leaves the facility on a regular basis and signs out and signs back in using their facility log. Manager stated R1 is capable of being in the community unassisted and knows the area well. The Manager also stated R1 has a cell phone but refuses to answer it when staff call. The facility also has R1's friend's contact information and will get a hold of R1's friends to verify R1's location. There have never been any issues with R1 being in the community. Manager believes R1 is able to be in the community unassisted and will discuss the issue with R1's Physician to update the Physician's Report that currently indicated R1 is not allowed to leave unassisted. Once the facility was made aware R1 was out of the facility and didn't return they followed their Absentee Notification Plan. The facility cannot force a resident to remain in the facility. The facility acted appropriately by following their absentee plan.

No deficiencies were issued. 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.
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.

LIC809 (FAS) - (06/04)
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