552700409-7-30-2021-27-AS-SDOB-C5XNGD-20210816102658

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 552700409
Report Date: 07/30/2021
Date Signed: 07/30/2021 03:44:24 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
05/21/2021 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20210521154735

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: 59	DATE:	07/30/2021
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Michael Maloney		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff are not ensuring that residents receive meals

Facility staff are not assisting residents with hygiene needs

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 27-AS-20210521154735

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: 07/30/2021

NARRATIVE

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Continued from pg 1....being served in the facility. Residents interviewed did not express any concerns regarding food service. Regarding allegations that resident’s hygiene needs are not being met. LPA’s spoke with Assistant Administrator Miranda and asked to see the Daily Incontinence Body logs and Hygiene Log for all residents. The logs were current and showed that resident’s were prompted to shower every other day. Staff signed acknowledging if the resident showered or declined to shower daily.

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.

An exit interview was conducted with Administrator and a copy of this report along with confidential names list was provided.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
05/21/2021 and conducted by Evaluator Sarah Hurt

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20210521154735

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:	DATE:	07/30/2021
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Michael Maloney		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility is in disrepair
Facility is not kept clean

INVESTIGATION FINDINGS:

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Licensing Program Analyst Sarah Hurt and Licensing Program Manager Stephanie Doub conducted an unannounced visit to the facility on July 30,2021 to deliver complaint findings. LPA and LPM identified themselves and discussed the purpose of the visit with Administrator Michael Maloney.
It was alleged that the facility is not clean and the facility is in disrepair. This investigation consisted of interviews with facility management and residents. Also reviewing of the resident files and facility records.
Regarding the allegation’s that the facility is not kept clean and facility is in disrepair. LPA’s toured the facility and observed the elevator flooring to consist of a piece of plywood. The elevator inspection certificate expired June 26,2020. LPA’s toured the hallways and resident rooms. LPA’S smelled a strong odor of incontinence in the hallways and some of the resident rooms. LPA’s cited the facility under 87303(a) Maintnence and Operations. Based on LPA’s findings and observations the above allegations are determined to be SUBSTANTIATED.
The following deficiencies were cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Maloney and a copy of this report along with appeal rights was provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 27-AS-20210521154735

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/30/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/30/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	Deficincies corrected at time of visit. Carpets were cleaned and elevator has valid permit.
	8 9 10 11 12 13 14	This requirement has not been met as evidenced by: LPA's smelled incontinence odors on carpet throughout facility. LPA's also observed elevator inspection certificate expired June 26, 2020.This is an immediate safety risk to the residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC9099 (FAS) - (06/04)

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