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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134604417
Report Date: 02/18/2022
Date Signed: 02/18/2022 09:16:28 PM

Document Has Been Signed on 02/18/2022 09:16 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:GUEVARA, ITZELFACILITY TYPE:
740
ADDRESS:708 E. 5TH ST.TELEPHONE:
(760) 356-1262
CITY:HOLTVILLESTATE: CAZIP CODE:
92250
CAPACITY: 175CENSUS: 83DATE:
02/18/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Itzel Guevara, Care Coordinator Gabriela Zamora, and Assistant Care Coordinator Evelyn ReyesTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Dang Nguyen and Licensing Program Manager (LPM) Simon Jacob conducted an announced COVID-19 Case Management visit, accompanied by specialists Cintya Coronado and Steven Solis from the Imperial County Public Health Department. The above persons were welcomed by, identified themselves to, and discussed the purpose of the visit with Administrator Itzel Guevara, Care Coordinator Gabriela Zamora, and Assistant Care Coordinator Evelyn Reyes.

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's COVID-19 screening, testing, and disinfection processes and the staff’s use of personal protective equipment. During the visit, LPA, LPM, and health department personnel briefly toured the facility, interacted with staff and residents, and interviewed the administrator. No deficiencies were cited during this visit.

An exit interview was conducted with Guevara, Zamora, and Reyes. A copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided to the administrator via E-mail.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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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