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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 134604417
Report Date: 01/08/2026
Date Signed: 01/08/2026 07:41:27 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
05/22/2025 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20250522100402
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: 79DATE:
01/08/2026
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH: Licensee, Kamran ShiraziTIME COMPLETED:
08:00 PM
ALLEGATION(S):
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Staff did not properly report an incident involving a resident
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Natasha Persaud, Amy Rodgers, Amy Domingo, Licensing Program Maanger (LPM) Lizette Tellez, and Regional Manager, Jerry Romero conducted an unannounced visit to deliver findings in the above complaint allegation. The purpose of the visit was discussed with Licensee, Kamran Shirazi and Administrator, Teresita Reyes.

On May 22, 2025, Community Care Licensing (CCL) received a complaint alleging facility staff did not contact emergency personnel after Resident #1 (R1) was found to be missing. Details of the allegation state that on May 20, 2025, R1 left the facility unassisted at 11:34am and did not return for lunch. According to R1’s Physician’s Report dated March 9, 2025, R1 is allowed to leave unassisted, has mild-cognitive impairment and is ambulatory. Interview with Facility Manager established that R1 had a change in condition roughly three months before this incident but had not developed wandering tendencies. Interview with R1’s responsible party established that they were concerned about R1’s recent memory loss and was diagnosed with mild cognitive impairment with onset of dementia. Continued on LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR 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.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 08-AS-20250522100402
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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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Interview with multiple staff revealed that R1’s daily routine included leaving the facility for daily walks but would regularly return for meals or by 2:00pm for their afternoon coffee. Staff revealed that they were then instructed to search for R1 inside and outside of the facility but did not find them. Records collected reveal that facility’s absentee notification plan states the facility staff will contact emergency personnel after 30 minutes of residents being noted missing. Emergency department records collected revealed that facility reported R1 missing on 5/20/2025 at 6:13pm, roughly six hours after identifying R1 missing. Records also revealed that facility manager stated they had not contacted emergency personnel because they were hopeful staff would find R1. On 5/21/2025 at about 12pm, R1 was found deceased in a canal roughly six (6) miles away from the facility. Death records confirmed that R1’s manner of death was accident with a sub manner of death as drowning.  

Based on interviews conducted, review of records, including outside sources records, a preponderance of evidence exists to support the allegation. Therefore, the allegation was substantiated. A deficiency was cited per the Health and Safety Code (refer to the attached LIC 9099-D). The Department has determined this violation resulted in death to the resident in care.  An immediate Civil Penalty of $500.00 is charged and is noted on the LIC421IM.  Currently, per Health and Safety Code Section 1569.49, an additional civil penalty assessment is under review by the Program Administrator of Community Care Licensing Division. An exit interview was conducted with Licensee, Kamran Shirazi. and a Plan of Correction was jointly developed. A copy of this report, LIC811, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to Licensee, Kamran Shirazi, signature on this form confirms receipt of documents. 
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR 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
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20250522100402
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
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
HSC
1569.317
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Absentee notification plan for missing residents. Every residential care facility...issues that arise when a resident is missing from the facility...Section 1569.80. The plan shall include... requirement that an administrator of the facility, or his or her designee, inform the resident’s authorized representative when that resident is missing from the facility and the circumstances in which an administrator of the facility, or his or her designee, shall notify local law enforcement when a resident is missing from the facility.
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Licensee will have staff trained regarding Absentee notification plan for missing residents by a vendor. Licensee will submit proof of scheduled training date by POC due date. In addition, the training will be submitted within 2 weeks.
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This requirement is not met as evidenced by:
Based on interviews and record review, the licensee did not follow their Absentee Notification Plan for 1 out of 79 [R1] residents, which posed an immediate health and safety risk to residents in care.
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An immediate civil penatly was assessed.
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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: 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
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
05/22/2025 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20250522100402

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: 79DATE:
01/08/2026
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH: Licensee, Kamran ShiraziTIME COMPLETED:
08:00 PM
ALLEGATION(S):
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Lack of Supervision Resulted in resident death
Staff did not prevent a resident from wandering while in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Natasha Persaud, Amy Rodgers, Amy Domingo, Licensing Program Maanger (LPM) Lizette Tellez, and Regional Manager, Jerry Romero conducted an unannounced visit to deliver findings in the above complaint allegation. The purpose of the visit was discussed with Licensee, Kamran Shirazi and Administrator, Teresita Reyes.

On May 22, 2025, Community Care Licensing (CCL) received a complaint alleging lack of supervision resulted in Resident 1 (R1) death and staff did not prevent R1 from wandering while in care. Details of the first allegation state that on May 20, 2025, R1 left the facility unassisted at 11:34am and was later found deceased. According to Physician Report dated March 9, 2025, R1 is allowed to leave unassisted, has mild-cognitive impairment and is ambulatory. Interview with multiple staff revealed that R1’s daily routine included leaving the facility unassisted for daily walks and returning to the facility for lunch or by 2pm daily. Interviews with the party responsible revealed that R1 was very independent and corroborated that R1 enjoyed daily walks. Death records confirmed that R1 manner of death was an accident. Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR 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.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20250522100402
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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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It was also alleged that staff did not prevent R1 from wandering while in care. Based on records collected, there were no medical limitations to prevent R1 from leaving the facility unassisted and R1’s walking away from the facility was normal behavior. Interview with multiple staff revealed R1 would always return from such daily walks. Interview with the party responsible corroborated such information.  

Based on records and interviews conducted by the Department, there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Licensee, Kamran Shirazi, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided. 
 
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR 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
LIC9099 (FAS) - (06/04)
Page: 5 of 5