552700409-2-17-2023-27-AS-CVAO-CP5UPK-20230217144541

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 02/16/2023
Date Signed: 02/17/2023 02:45:48 PM

Document Has Been Signed on 02/17/2023 02:45 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 LIVING		FACILITY NUMBER:	552700409
ADMINISTRATOR:	ERNEST G GIBSON		FACILITY TYPE:	740
ADDRESS:	18760 CHABROULLIAN LN		TELEPHONE:	(209) 984-5124
CITY:	JAMESTOWN	STATE: CA	ZIP CODE:	95327
CAPACITY:	90	CENSUS: 50	DATE:	02/16/2023
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	02:56 PM
MET WITH:	Ernest Gibson, Wanda Wolski, Georgina Rodriguez, Asok Kumar		TIME COMPLETED:	04:00 PM

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An office meeting was held today in the Sacramento South Regional Office via Microsoft Teams. The purpose of the meeting is to discuss the recent Stipulation and Waiver; and Order effective 01/26/23. Present in the meeting were Community Care Licensing Representatives: Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Stephen Richardson, Licensing Program Manager (LPM) Emerita Curiel, Licensing Program Analyst (LPA) Christina Valerio; GOLDEN LVG CONGREGATE NOR-CAL; SENIOR CARE OF CA Representatives: Licensee Georgina Rodriguez, Licensee Asok Kumar, Administrator Ernest Gibson, and Human Resources Manager Wonda Wolski.

Topics of Discussion

Stipulation and Waiver; And Order (CDSS. No. 8121356104)

The facility will do the following:

Per Health and Safety Code 1569.191 H&S Code, all current and new residents are to be advised of the intent to sale the property effective 07/2022
According to the stipulation order, all parties are to be notified of stipulation order effective 01/26/23
According to the stipulation order, by no later than March 2nd, 2023, all residents and responsible parties shall be given a 60- day written notice stating the Respondents may no longer provide care and supervision after the closure date and that all clients require care and supervision will be required to relocate if respondents are unable to complete a sale or transfer of the facility .
If a buyer is not identified, there will be no new admissions after March 2, 2023

Continues on LIC 809 - C...

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 LIVING	FACILITY NUMBER: 552700409
	VISIT DATE: 02/16/2023

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Continues from LIC 809

The facility will do the following:

After March 2, 2023, the licensee is to provide LPA Valerio a copy of the resident roster with resident's responsible party contact information and cost of rental fees
Continue to follow stipulation orders and meet additional stipulation deadlines as discussed in the order
Maintain compliance with Title 22 regulations

Representatives of GOLDEN LVG CONGREGATE NOR-CAL; SENIOR CARE OF CA acknowledge the understanding of the stipulation order. Questions were addressed. It was determined there were no further questions. At this time, representatives did not comment on the status of a prospective buyer.

The Regional Office will do the following:

Continue to conduct Health and Safety Unannounced Visits
Continue to work with facility administrator, licensee, and staff to ensure compliance of Title 22 regulations and the health and safety of the residents in care

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC809 (FAS) - (06/04)

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