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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134604417
Report Date: 01/08/2026
Date Signed: 01/08/2026 08:11:46 PM

Document Has Been Signed on 01/08/2026 08:11 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
SAN DIEGO RO, 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: 79DATE:
01/08/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Licensee, Kamran Shirizi,TIME VISIT/
INSPECTION COMPLETED:
08:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Amy Rodgers, Amy Domingo and Natasha Persaud, Licensing Program Manager (LPM), Lizzette Tellez and Regional Manager (RM), Romero conducted an unannounced
Case Management - Other. The purpose of the visit was discussed with Facility Manager, Gabriela Zamora, Licensee, Kamran Shirizi, and Administrator, Teresita Reyes

On January 8, 2026, the department visited the facility to commence a Health and Safety check. During the visit, Guardian Background Clearance System was reviewed. It was discovered some staff were not fingerprint cleared or associated to the facility. Staff #1 (S1), is the current Administrator and has a current administrator certificate posted inside the facility. S1 has an active background clearance; however, S1 is not associated to the facility. It was also discovered Staff #2 (S2) and Staff #3 (S3) and Staff #4 (S4) do not have fingerprint clearances and are not associated with the facility.

During the facility tour, the department observed that the oven in the kitchen was inoperable. Staff confirmed the oven has been inoperable for approximately three (3) months. The department also reviewed the posted menu and discovered that the facility is not following their posted menu. Also, the facility did not have the required two (2) day non-perishable food supply.

(Continued on LIC809C)

NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Amy Rodgers
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 01/08/2026 08:11 PM - It Cannot Be Edited


Created By: Amy Rodgers On 01/08/2026 at 03:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SONRISA VILLA INC.
FACILITY NUMBER: 134604417

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/09/2026
Section Cited
CCR
87355(e)(3)

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87355 Criminal Record Clearance (e) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility (3) Request a transfer of a criminal record clearance... This requirement was not met as evidenced by:
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Licensee agreed not to allow staff to work or be present in the facility until S1 - S4 have been fingerprinted and associated to the facility. Provide proof of Guardian Association by POC date.
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Based on record review, the licensee did not ensure that a criminal record clearance transfer was complete for 1 of 30 staff members prior to working in the facility, which poses an immediate health, safety and personal rights risk to 79 of 79 residents in care.
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A civil penalty was assessed.
Type B
02/09/2026
Section Cited
CCR87303(a)

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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Licensee agreed to ensure the oven is operable by POC date.
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This requirement was not met as evidenced by: Based on record review, the licensee did not ensure that the oven in the facility kitchen was working in the facility, which poses an potential, safety and personal rights risk to 79 of 79 residents in care.
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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.
Simon Jacob
NAME OF LICENSING PROGRAM MANAGER:
Amy Rodgers
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2026


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SONRISA VILLA INC.
FACILITY NUMBER: 134604417
VISIT DATE: 01/08/2026
NARRATIVE
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(Continued from 809)

On 1/8/26, During review of facility personnel records, it was observed that the facility failed to keep required personnel records. LPA requested and reviewed 4 personnel files for staff employed. Deficiencies observed included: Missing or incomplete job application/resume and employment references for 4 staff. Missing health screening (physician’s report) and/or TB test results for 4 staff. Missing First Aid/CPR certificates for 4 staff providing direct care. Missing orientation/training documentation (including personal rights, emergency procedures, dementia/wandering if applicable) for 4 staff. Missing proof of criminal record clearance and association to the facility for 4 staff. Based on records reviewed the licensee failed to maintain complete and current personnel records as required by regulation.


Deficiencies were cited on the attached LIC 809(d) and Civil Penalties assessed and noted on the LIC421BG. A plan of correction was jointly developed with the licensee.

An exit interview was conducted with Licensee Kamran Shirazi, and a copy of this report along with Licensee/Appeal Rights were provided at the conclusion of the visit. Their signature on this report acknowledges receipt of these reports and licensee rights.
NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Amy Rodgers
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 01/08/2026 08:11 PM - It Cannot Be Edited


Created By: Amy Rodgers On 01/08/2026 at 07:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SONRISA VILLA INC.
FACILITY NUMBER: 134604417

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2026
Section Cited
CCR
87555(a)

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General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents.... All food shall be selected, stored, prepared and served in a safe and healthful manner.
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Licensee purchased a 2 day supply of perishable food on 1/8/2026. Licensee will send weekly photos of purchased food items along with receipts by POC due date.
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This requirement was not met as evidenced by: Based on record review, the licensee did not ensure that the oven in the facility kitchen was working in the facility, which poses an potential, safety and personal rights risk to 79 of 79 residents in care.
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Type B
02/09/2026
Section Cited
CCR87412(a)

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Personnel Records(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:
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Licensee agreed to ensure all staff records are current and maintained by POC due date.
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This requirement was not met as evidenced by: Based on record review, the licensee did maintain personnel records, which poses an potential, safety and personal rights risk to 79 of 79 residents in care.
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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.
Simon Jacob
NAME OF LICENSING PROGRAM MANAGER:
Amy Rodgers
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2026


LIC809 (FAS) - (06/04)
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