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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 11/22/2022
Date Signed: 11/22/2022 03:30:14 PM


Document Has Been Signed on 11/22/2022 03:30 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:ERNEST G GIBSONFACILITY TYPE:
740
ADDRESS:18760 CHABROULLIAN LNTELEPHONE:
(209) 984-5124
CITY:JAMESTOWNSTATE: CAZIP CODE:
95327
CAPACITY:90CENSUS: 59DATE:
11/22/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Ernest GibsonTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a case management visit. LPA met with Administrator Ernest Gibson, and explained the purpose of the visit.

LPA observed residents listening to music, eating lunch, decorating cookies, and being assisted by staff with ADLs. Today for lunch the residents had meat loaf with gravy, mash potatoes, and steamed veggies.

According to interviews, the facility is fully stocked with PPE, food supplies, and hygiene supplies. For the Thanksgiving Holiday, the facility will prepare turkey, salad, dessert, and holiday sides. The new activities director will be hosting a happy hour for the residents. Residents will be able to enjoy drinks (wine and non-alcoholic), snacks, and good music. According to interview with resident and staff, the activities director is happy, has good energy, and getting the residents involved in daily activities.

LPA met with Administrator Ernest and discussed the current status of the facility along with consistent issues observed with the facility.

Per California Code of Regulations, Title 22, no deficiencies are being cited today. An exit interview was held with Administrator Ernest Gibson, 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: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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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