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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 11/29/2022
Date Signed: 11/29/2022 12:53:12 PM


Document Has Been Signed on 11/29/2022 12:53 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:
11/29/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Ernest G GibsonTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Christina Valerio and LPA Ivey-Canady arrived at the facility unannounced to conduct a case management visit. LPAs met with Human Resources Manager Wanda Wolski and was later met by Administrator Ernest Gibson.

LPAs toured the facility inside and out to ensure the health and safety of the residents in care. LPAs observed 3 floor staff, 3 kitchen staff, 1 house keeper, and 1 activities director. LPAs observed the kitchen appliances, which were in working condition. Today for lunch, the facility served lasagna, vegetables, brownies, juice, and water.

LPAs interacted with residents and staff during the visit. Staff were assisting residents with ADLs, medications, breakfast/lunch service, and conducting rounds.

Residents were observed watching television in the main lobby area on the 3rd floor and on the 1st floor. On the second floor, residents were observed in their bedrooms and a few residents on the porch smoking a cigarette.

According to the Administrator, the licensee approved for new floors to be installed on the second floor in the upcoming weeks. Administrator stated that the installation will take one day.

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 given.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022
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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