315920051-7-16-2026-59-AS-TORZ-DX9V6S-20260824161002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315920051
Report Date: 07/16/2026
Date Signed: 07/16/2026 01:58:37 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
06/10/2026 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20260610084730

FACILITY NAME:	SONRISA SENIOR LIVING		FACILITY NUMBER:	315920051
ADMINISTRATOR:	CLYMO, MICHAEL		FACILITY TYPE:	740
ADDRESS:	1031 ROSEVILLE PKWY		TELEPHONE:	(279) 213-0047
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95678
CAPACITY:	199	CENSUS: 144	DATE:	07/16/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Michael Clymo		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident food not prepared in a safe manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 7/16/26, Licensing Program Analyst (LPA) Kevin Mknelly spoke with Exec. Dir. (ED), Michael Clymo, to deliver complaint findings for the above allegation.
LPA reviewed resident records, facility records, food inspection and conducted interviews.
LPA finds that the allegations cited above are substantiated.

It was reported that on 6/7/26, R1 received pureed fruit, prepared by S1, that when served by R1's private caregiver, was found to contain small pieces of plastic.
LPA reviewed photos of the food and physically examined the food. Plastic of variable sizes were found to be present in the food.
In interview with S1 on 7/16/26, S1 described what they could recall as the preparation of R1's pureed fruit on 6/7/26. S1 recalled being in a hurry and that the supply of normally used Thick-it was not available. As a Thick-it substitute, S1 used a piece of bread. The bread loaves have small white tab closures similar to the color and thickness of the plastic found in the food served to R1. S1 did not specifically recall though stated that the loaf of bread used may or may not have been in close proximity to the food prepared.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

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 4

Control Number 59-AS-20260610084730

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
	VISIT DATE: 07/16/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On 6/17/26, LPA conducted a kitchen inspection. LPA found no other items or utensils in the kitchen other that the bread closure tabs that matched the color and thickness that matched the plastic found in the food delivered to R1.

The contaminated food was discovered by care providers before food was eaten by R1. No harm resulted to R1 as a result.

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 . Copy of this report and appeal rights provided.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 59-AS-20260610084730

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: 07/16/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/30/2026 Section Cited CCR 87555(b)(9)	1 2 3 4 5 6 7	General Food Service Requirements (b)(9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement was not met based on observations and statements.	1 2 3 4 5 6 7	Executive Director will conduct a training of kitchen staff regarding safequards for ensuring foreign substances do not come into contact with food served to residents. Proof of training to be submitted by the POC date of 7/30/26.
	8 9 10 11 12 13 14	R1 was served food which was improperly prepared resulting in a foreign substance being in R1's food. This posed a potential risk to the resident.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 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.

SUPERVISOR'S NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

LIC9099 (FAS) - (06/04)

Page: 3 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
06/10/2026 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20260610084730

FACILITY NAME:	SONRISA SENIOR LIVING		FACILITY NUMBER:	315920051
ADMINISTRATOR:	CLYMO, MICHAEL		FACILITY TYPE:	740
ADDRESS:	1031 ROSEVILLE PKWY		TELEPHONE:	(279) 213-0047
CITY:	ROSEVILLE	STATE:CA	ZIP CODE:	95678
CAPACITY:	199	CENSUS: 144	DATE:	07/16/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Michael Clymo		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff threatened resident with involuntary discharge.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 7/16/26, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with ED, Mchael Clymo.
LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.
Interviews and records review found that upon R1's return from hospitalization for a recent food choking incident, R1 had physician's recommendation for a modified diet and 1:1 supervision while eating of drinking.
Given the recent incident it was recommended by the facility management that R1 either return to skilled nursing or have round the clock 1:1 observation. While family disagreed that R1 required 1:1 outside of eating or hydration, family acquiesced and provided 1:1 private care attendants.
R1 was not involuntarily transferred and facility staff's recommendation did not constitute a "threat".
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: Troy Ordonez
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

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 4