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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 04/12/2023
Date Signed: 04/13/2023 10:55:50 AM


Document Has Been Signed on 04/13/2023 10:55 AM - 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: 33DATE:
04/12/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ernest Gibson TIME COMPLETED:
07:30 PM
NARRATIVE
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Community Care Licensing Assistant Program Administrator (APA) Pam Gill, Licensing Program Manager (LPM) Stephen Richardson, Licensing Program Analyst (LPA) Christina Valerio arrived for the purpose of delivering a Temporary Suspension Order (TSO) on today's date of 04/12/2023 that is effective as to today's date. The aforementioned individuals met with Facility Administrator, Ernest Gibson. APA Gill reviewed the TSO paperwork with Licensee Georgina Rodriguez and Asok Kumar over the phone. A copy of the TSO paperwork was provided to Licensee later during the visit. Licensee Georgina Rodriguez and Asok Kumar arrived at the facility at 2:45 PM. APA Gill provided the Appeal/Notice of Defense process and advised that the facility is unable to accept residents at this time due to the TSO. The licensee was advised that the Department has implemented a Temporary Manager, Robert Cantoria, as of today's date who will assume all operations of the facility. A copy of the TSO paperwork was left with Administrator Ernest on today's visit.

APA Gill, LPM Richardson, LPA Valerio, Administrator Gibson, and Temporary Manager Cantoria toured the facility. There are currently 33 residents in care. As of today, there are 2 residents scheduled to move out on 04/13/23 and 04/14/23. Administrator Ernest provided an updated copy of the most recent resident registry roster.

A tour was conducted to ensure there was no immediate health or safety risk to residents in care. It was observed that the food order is scheduled to arrive in the afternoon. The facility was observed to have a minimum of 7 days of non-perishables and 2 days of perishable foods. Local Long Term Care Ombudsman Jill and Janice were also present during the tour. An impromptu meeting was held with CCL, LTCO, facility administrator, and facility staff to discuss the TSO and what to expect in the next upcoming days.

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, no deficiencies were observed. Exit interview held with Administrator Ernest and Licensee Gina/Asok and a copy of the report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
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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