496803736-5-28-2021-21-AS-KMOA-C3KQ3T-20210601114915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803736
Report Date: 05/24/2021
Date Signed: 05/28/2021 01:40:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2021 and conducted by Evaluator Victoria Willis

COMPLAINT CONTROL NUMBER: 21-AS-20210426140516

FACILITY NAME:	SUNRISE VILLA SONOMA		FACILITY NUMBER:	496803736
ADMINISTRATOR:	CORNEJO, WENDY		FACILITY TYPE:	740
ADDRESS:	91 NAPA RD		TELEPHONE:	(707) 939-1500
CITY:	SONOMA	STATE: CA	ZIP CODE:	95476
CAPACITY:	105	CENSUS:	DATE:	05/24/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator, Wendy Cornejo		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analysts Willis and Gonazalez-Campos met with Administrator Wendy Cornejo to deliver findings on the above-mentioned complaint allegation. Visit was conducted remotely to observe Covid-19 precautions.

LPAs conducted interviews with staff and other witnesses and reviewed documents. Complaint alleges that the power in resident room was not working. Based on interviews, power was out due to a popped breaker and staff were able to turn power back on immediately.

This agency has investigated the complaint alleging that facility is in disrepair. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies cited during this inspection.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2021 and conducted by Evaluator Victoria Willis

COMPLAINT CONTROL NUMBER: 21-AS-20210426140516

FACILITY NAME:	SUNRISE VILLA SONOMA		FACILITY NUMBER:	496803736
ADMINISTRATOR:	CORNEJO, WENDY		FACILITY TYPE:	740
ADDRESS:	91 NAPA RD		TELEPHONE:	(707) 939-1500
CITY:	SONOMA	STATE: CA	ZIP CODE:	95476
CAPACITY:	105	CENSUS:	DATE:	05/24/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator, Wendy Cornejo		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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9

Staff failed to keep the resident's room clean

INVESTIGATION FINDINGS:

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13

Licensing Program Analysts Willis and Gonazalez-Campos met with Administrator Wendy Cornejo to deliver findings on the above-mentioned complaint allegation. Visit was conducted remotely to observe Covid-19 precautions.

LPAs conducred interviews with staff and other witnesses and reviewed documents. Complaint alleges that resident's room was dusty and attributed the dust to a faulty HVAC system. Based on quartely inspections from the HVAC vendor and interviews, facility has not had any issues with the HVAC system. Multiple interviews denied excessive dust in resident rooms.

A finding that the complaint allegation that staff failed to keep the resident's room clean was unsubstantiated meaning that although the allegation may have happened there is not a preponderance of evidence to prove that the allegation occurred. We have therefore dismissed the complaint.

No deficiencies cited during this inspection.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 2