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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 01/14/2021
Date Signed: 02/23/2021 12:01:10 PM

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:KATRYNA HUNTFACILITY TYPE:
740
ADDRESS:18760 CHABROULLIAN LNTELEPHONE:
(209) 984-5124
CITY:JAMESTOWNSTATE: CAZIP CODE:
95327
CAPACITY:90CENSUS: 60DATE:
01/14/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Administrator, Katryna HuntTIME COMPLETED:
04:00 PM
NARRATIVE
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On 1/14/21 Licensing Program Analyst (LPA) Kevin Gould conducted a tele-visit with Administrator Katryna Hunt to discuss ongoing concerns with response testing for residents for COVID 19 as facility has both positive residents and staff and have not conducted response testing for all residents despite some residents testing positive beginning 12/29/21.

LPA Gould and Administrator discussed ongoing concerns with testing remaining residents who have either not been tested or tested negative during previous testing. LPA Gould and Licensing Program Manager (LPM) Czarrina Camilon-Lee had pervious conversations with administrator and licensee to ensure testing would be conducted. As of todays report, 40 residents have not been tested for COVID 19 and facility could not provide documentation of schedules or appointments for remaining residents' testing.

LPA Gould inquired as to what barriers facility has in testing the remaining residents and transporting them to local testing location which has been identified as a potential testing location for residents by administrator for several weeks. Administrator stated the facility does not have adequate transportation or facility vehicle to transport residents from the facility to testing location which contradicts the facility's approved plan of operation which states "... a facility vehicle shall be available and maintained in safe operating conditions at all times. Administrator stated that licensee had made inquiries for providing/contacting for larger transportation to transport residents for testing and could not provide updates or any scheduled transportation services for residents to be transported to testing site.

Based on the information obtained during interview with Administrator, the following deficiencies are cited. See LIC 809-D.

A copy of this report and appeal rights have been mailed to the facility for signature.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/15/2021
Section Cited

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Employee Actions: Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California. This requirement is not met as evidenced by: Not complying with the local health
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department and CCL requirements for response testing for residents in COVID positive facilities in a timely manner. 40 residents remain untested since initial positive resident on 12/29/2020 which poses an immediate health and safety risk for residents in care.
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Type A
01/15/2021
Section Cited

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Plan of Operation: Transportation arrangements for persons served who do not have independent arrangements. This requirement is not met as evidenced by facility not maintaining a vehicle to transport residents in accordance with the submitted plan of operation and not
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making transportation arrangements in timely manner to have residents tested for COVID 19 since initial positive residents were reported in December 2020 which poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2021
LIC809 (FAS) - (06/04)
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