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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 03/06/2023
Date Signed: 03/06/2023 01:39:51 PM


Document Has Been Signed on 03/06/2023 01:39 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: 50DATE:
03/06/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Facility StaffTIME COMPLETED:
01:50 PM
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Licensing program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a case management visit to ensure stipulation orders were being followed.  LPA met with facility staff, and explained the purpose of the visit.

The facility was issued a Stipulation and Waiver; and Order effective 01/26/23. The facility is currently undergoing a revocation of license. On 02/16/23, the Regional Office and Licensee representatives conducted an office meeting to review and discuss the Stipulation. All parties acknowledge understanding of Stipulations and expectations of the department. It was the facility responsibility to ensure the stipulation orders were followed to its entirety. On 03/02/23, the facility was to provide a 60-day Eviction letter along with information regarding potential sale or transfer of facility to all residents and responsible parties. Facility Administrator submitted an email to the Regional Office on 03/02/23; however, the email had many components missing. Facility Administrator was advised by Regional Manager (RM) Doub of missing information that needed to be included in the letter. LPA Valerio spoke to Administrator Ernest on 03/03/23. LPA reminded Ernest of stipulation orders, read page 3, line 9 of the stipulation to him, and requested he send a completed copy to LPA. As of 03/06/23, a corrected letter has not been sent out to client and responsible parties. LPA requested a copy of the updated letter be sent to LPA by 03/10/2023. The facility shall no longer accept new residents in care. As of today, there are 50 residents in care. Licensee is to maintain a live resident roster with accurate and up to date information. LPA requested the resident roster be sent to LPA by 03/10/2023.
LPA told facility staff to inform administrator Ernest to review the stipulation. The Stipulation and Waiver; and Order is a public document; therefore, residents, responsible parties, and staff shall be directed to where they can review a copy. Administrator Ernest was also reminded to cooperate with appropriate agencies as necessary to assist with the relocation of clients should they want to leave prior than the stay period end date of 05/31/23.

An exit interview was held with facility staff, and a copy of the report provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2023
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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