552700409-12-12-2022-27-AS-SDOB-CN7M7S-20230118082201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 552700409
Report Date: 12/12/2022
Date Signed: 12/12/2022 12:11:52 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/29/2022 and conducted by Evaluator Ruth Wallace

COMPLAINT CONTROL NUMBER: 27-AS-20220329145357

FACILITY NAME:	SONORA SENIOR LIVING		FACILITY NUMBER:	552700409
ADMINISTRATOR:	MICHAEL MALONEY		FACILITY TYPE:	740
ADDRESS:	18760 CHABROULLIAN LN		TELEPHONE:	(209) 984-5124
CITY:	JAMESTOWN	STATE: CA	ZIP CODE:	95327
CAPACITY:	90	CENSUS: 59	DATE:	12/12/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Human Resources Manager - Wanda Wolski		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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9

Resident regularly beats up residents, who are then hospitalized.

INVESTIGATION FINDINGS:

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13

Licensing Program Analyst (LPA) Ruth Wallace made an unannounced visit to the facility on this day for the purpose of concluding a complaint investigation. LPA met with Human Resources Manager and explained the reason for the visit.
The initial 10-day visit was conducted on 4/1/2022 where LPA obtained documents including but not limited to physician reports, staff schedule, resident roster, staff roster with staff’s contact information and Needs and Services Plans. During the investigation, the Department conducted interviews with staff and residents and reviewed medical records.
It was alleged that staff did not provide appropriate supervision of residents, by allowing resident to regularly beat up other residents who are then hospitalized. On 3/29/2022, Resident 1 (R1) was hospitalized for a nasal fracture. Based on interview with treating Emergency Room physician of R1, it appeared that R1 had fallen. Due to medical conditions, R1 was unable to provide any details of how their injuries occurred only stating, “He hit me.” It was unclear if R1’s injuries were due to being hit or from a fall. Based on medical records and interviews, there was not a preponderance of evidence to prove that the incident occurred as alleged therefore this allegation was deemed UNSUBSTANTIATED. An unsubstantiated finding means there is not a preponderance of evidence to prove or disprove that the allegation occurred.
An exit interview was conducted with Human Resources Manager and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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