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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 11/14/2022
Date Signed: 11/14/2022 02:54:17 PM


Document Has Been Signed on 11/14/2022 02:54 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:
11/14/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Human Resource Manager, Wanda WolskiTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a case management visit. LPA Valerio met with Human Resource Manager, Wanda Wolski, and explained the purpose of the visit.

LPA Valerio was made aware that 7 staff, including previous Residential Care Coordinator Maranda Escobedo, separated themselves from the facility effective 11/09/22. The facility stated they are short staff; however, have plans in place to address the shortage. Staff from administrative office and care giving staff are helping ensure the facility is covered in the kitchen. Floor staff are also working over time. According to interviews, overtime was not approved previously but is approved moving forward. LPA obtained records regarding this matter for department review.

LPA interviewed residents, staff, and an outside agency during the visit. LPA interviewed the administrator Ernest via telephone. Based on information obtained during interviews, LPA requested resident and facility files for department review and will follow up on a later date.

LPA observed the facility inside and out to ensure compliance of Title 22 regulations. Facility was observed to be the same condition as previous visits. The main floor (3rd) was decorated with Christmas decor. Residents were observed to eating breakfast and lunch. Lunch today was rice, chicken, white gravy, corn, and chocolate pudding along with choice of beverage. LPA received mixed reviews from residents on the taste of lunch. A picture of lunch was obtained for records.

Per California Code of Regulations, Title 22, no deficiencies are being cited today. An exit interview was held with facility staff, and a copy of the report was left.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2022
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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