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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 11/09/2022
Date Signed: 11/09/2022 04:01:10 PM


Document Has Been Signed on 11/09/2022 04:01 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:SONORA SENIOR LIVINGFACILITY NUMBER:
552700409
ADMINISTRATOR:MICHAEL MALONEYFACILITY TYPE:
740
ADDRESS:18760 CHABROULLIAN LNTELEPHONE:
(209) 984-5124
CITY:JAMESTOWNSTATE: CAZIP CODE:
95327
CAPACITY:90CENSUS: 60DATE:
11/09/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maranda EscobedoTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a POC visit. LPA met with facility staff Maranda Escobedo and Wanda Wolski, and explained the purpose of the visit.

LPA Valerio toured the facility to ensure compliance with Title 22 regulations and to ensure the health and safety of the residents in care. LPA met with residents, staff, and outside agencies throughout the tour. According to interviews with staff, the facility may be short on kitchen staff in the upcoming days. To help alleviate the shortage, staff will be doing 12 hour shifts and trying to find on-call staff to cover. The facility has hired a new kitchen cook and activities director that will be starting this week. LPA observed their names on the fingerprint clearance list.

LPA toured the facility and observed the 1st floor of the building to be cold inside a few of the resident bedrooms. Towards the middle of the hallway, the rooms were warm. According to interviews with staff and residents, resident 1 (R1) wears layers of clothing during the day and night to keep warm. According to observations, the rooms toward the middle of the floor were warmer than the rooms on the outer edge. The facility does not have the ability to monitor individual rooms. The facility has a thermostat, which was set to 73*F degrees during the visit, is the only way for the facility to record and monitor the temperature. Technical Assistance was given to the facility to ensure residents are kept comfortable moving forward.

LPA obtained facility files from an incident that occurred on 11/05/22.

Per California Code of Regulations, Title 22, no deficiencies were cited on today's visit. Exit interview held, and a copy of the report was given.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2022
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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