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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 06/13/2023
Date Signed: 06/14/2023 09:27:59 AM


Document Has Been Signed on 06/14/2023 09:27 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:0CENSUS: 0DATE:
06/13/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 AM
MET WITH:Georgina RodriguezTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Christina Valerio and Licensing Program Manager (LPM) Stephen Richardson met with Licensee Georgina to conduct an Office Meeting via Microsoft Teams due to the facility being closed. The purpose of the meeting is to discuss complaint findings for 27-AS-20230320174301 and 27-AS-20221216090727.

LPA Valerio and LPM Richardson read the reports to Licensee Georgina and answered any questions Licensee Georgina had in regards to the report findings, appeal rights, and plan of corrections.

LPA Valerio informed Licensee Georgina to sign all forms and send them back to LPA Valerio. She was also reminded of the plan of correction due dates via e-mail.

Licensee Georgina was informed that LPA Valerio will be reaching out to schedule a time to deliver additional complaint findings.

An exit interview was held, 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: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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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