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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 02:50:16 PM


Document Has Been Signed on 11/14/2022 02:50 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:POCUNANNOUNCEDTIME 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 POC visit. LPA met with Human Resource Manager Wanda Wolski, and explained the purpose of the visit.

Licensee Georgina Rodriguez, Asok Kumar, and Administrator Ernest Gibson sent supportive documents for Administrator Ernest. LPA confirmed all documents were accurate and up to date. Administrator Certificate 6058629740, expiration date 02/04/2023, was observed to be on file with the department for Ernest G Gibson. Fingerprint clearance for Ernest was observed.

LPA Valerio observed the facility to have an Administrator as of 11/10/22. The original citing "Administrator Qualifications" 87405(a) took place on June 15th, 2022. LPA Valerio will not continue to assess civil penalties during the visit as the Plan of Correction has been met.
 
An exit interview was held with Human Resources Manager, Wanda Wolski, and a copy of the report was left at the facility. LPA informed Administrator Ernest of this report via telephone.
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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