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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920051
Report Date: 04/09/2025
Date Signed: 04/09/2025 04:04:57 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/09/2025 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20250109141346
FACILITY NAME:SONRISA SENIOR LIVINGFACILITY NUMBER:
315920051
ADMINISTRATOR:PICKARD, CAROLFACILITY TYPE:
740
ADDRESS:1031 ROSEVILLE PKWYTELEPHONE:
(279) 213-0047
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:199CENSUS: 124DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Michael ClymoTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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7
8
9
Staff did not ensure reporting requirements were followed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 On April 9, 2025, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Executive Director/ Administrator, Michael Clymo, to deliver complaint findings for the above allegation.
LPA reviewed resident records, facility records and conducted extensive interviews.
LPA finds that the allegations cited above are substantiated.
Interviews of facility staff found that when a infectious illness was discoverd at the facility and email was sent out to families. Due to a administrative error, family of R1 was left off the email list and not notified. This lead to exposure of family.
As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Report reviewed with executive director . Copy of this report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
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 59-AS-20250109141346
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SONRISA SENIOR LIVING
FACILITY NUMBER: 315920051
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/10/2025
Section Cited
CCR
87466
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7
Observation of resident- The licensee shall ensure that residents are regularly observed for changes... When changes such as ... physical health condition ... and brought to the attention of the resident's physician and the resident's responsible person...
This requirement was not met
1
2
3
4
5
6
7
During the investigation, the error was identified a and corrected.
This citation is cleared at the time of this visit.
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9
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13
14
based on statements that found responsible party was not notified timely of an infectious illness. This posed a potential risk to others.
8
9
10
11
12
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14
1
2
3
4
5
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7
1
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6
7
1
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7
1
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7
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: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/09/2025 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20250109141346

FACILITY NAME:SONRISA SENIOR LIVINGFACILITY NUMBER:
315920051
ADMINISTRATOR:PICKARD, CAROLFACILITY TYPE:
740
ADDRESS:1031 ROSEVILLE PKWYTELEPHONE:
(279) 213-0047
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:199CENSUS: 124DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Michael ClymoTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not ensure medications are dispensed as prescribed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On April 9, 2025, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Executive Director.

LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.

The allegation involved whether due to staff error R1 received consecutive day skin treatment and shower or whether R1 received once a week treatent and shower as prescribed. Records indicated that treatment was done as prescribed. However, interview statements by staff were at times contradictory. R1, due to cognitve issues was unable to accurately report what was experienced.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview with administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/09/2025 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20250109141346

FACILITY NAME:SONRISA SENIOR LIVINGFACILITY NUMBER:
315920051
ADMINISTRATOR:PICKARD, CAROLFACILITY TYPE:
740
ADDRESS:1031 ROSEVILLE PKWYTELEPHONE:
(279) 213-0047
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:199CENSUS: 124DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Michael ClymoTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not ensure an administrator or qualified staff is on site at all times.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 On April 9,2025, Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with Executive Director to deliver investigation findings.
LPA reviewed staff records, facility records, and conducted interviews.
LPA finds that facility met Tittle 22 requirements.
The incident alleged involved R1's return from a hospital visit for R1 and whether qualified staff were present to receive discharge information and new medications when R1 returned. Records and staements found that qualified staff were present to receive information and medications. A dedicated staff was present for the scheduled return time but the time changed. Though the intended staff were not present, other qualified staff are present at the facility at all times.
This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.
Exit interview conducted and report provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4