552700409-6-25-2021-27-AS-LKIG-C4H5TP-20210630201441

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 552700409
Report Date: 06/25/2021
Date Signed: 06/25/2021 12:26:34 PM

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
04/23/2021 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20210423121648

FACILITY NAME:	SONORA SENIOR LIVING		FACILITY NUMBER:	552700409
ADMINISTRATOR:	KATRYNA HUNT		FACILITY TYPE:	740
ADDRESS:	18760 CHABROULLIAN LN		TELEPHONE:	(209) 984-5124
CITY:	JAMESTOWN	STATE: CA	ZIP CODE:	95327
CAPACITY:	90	CENSUS: 62	DATE:	06/25/2021
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Michael Maloney and Wanda Wolski		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility temperature is not at a comfortable range
Resident's care needs are not being met (lost weight)

INVESTIGATION FINDINGS:

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LPAs Albert Johnson and Sarah Hurt conducted an unannounced complaint visit at the facility and met with Wanda Wolski to discuss and complete this complaint investigation. LPAs provided findings regarding the allegations listed above. The investigation was conducted by LPA Bruce Jacobs and consisted of interviews with facility management and staff and reviews of the facility records. Other witnesses were contacted and interviewed.

The complaint allegation listed above were investigated. Regarding the temperature of the facility, LPA Jacobs obtained information from facility staff, several Licensing Program Analysts and the reporter of this complaint that the temperature of the facility was at the appropriate range.

Continued

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021

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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Control Number 27-AS-20210423121648

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 06/25/2021

NARRATIVE

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Four Licensing Program Analysts made several visits over several months and found the facility at a comfortable range. The reporter of the complaint observed the temperate in the facility to be at 80 degrees F. Regulations call for a temperature range of 78 to 85 degrees.

Regarding the allegation that the resident’s needs were not met resulting in the resident losing weight. LPA Jacobs obtained the information from the facility nurse, facility records and other individuals regarding the care and condition of the resident. It was determined that the resident was 100 years old, on hospice and had received an order by her doctor for pureed food. The resident was reported to have stopped eating and the intake of supplements and her weight decreased from approximately 125 pounds to 115 pounds at the end of her life, as a result of not eating and not as a result of neglect.

The investigation concluded, based on interviews, inspections and file reviews that the allegations are unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has not been met, therefore the above allegations are determined to be UNSUBSTANTIATED.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021

LIC9099 (FAS) - (06/04)

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