552700409-10-20-2021-27-AS-KHOS-C7ZPV6-20211021113838

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 552700409
Report Date: 10/14/2021
Date Signed: 10/20/2021 12:04:10 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
10/12/2021 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20211012153023

FACILITY NAME:	SONORA SENIOR LIVING		FACILITY NUMBER:	552700409
ADMINISTRATOR:	MICHAEL MALONEY		FACILITY TYPE:	740
ADDRESS:	18760 CHABROULLIAN LN		TELEPHONE:	(209) 984-5124
CITY:	JAMESTOWN	STATE: CA	ZIP CODE:	95327
CAPACITY:	90	CENSUS: 50	DATE:	10/14/2021
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Michael Maloney, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff speaks inappropriately to residents
Facility does not order medications timely
Staff provides wrong medications to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPA'S) Sarah Hurt and Ruth Wallace arrived unnannounced to deliver findings on the above allegations. LPA's met with Administrator Michael Maloney and explained the purpose of today's visit.

Regarding the allegation Staff provides wrong medications to residents. Based on LPA's interviews, review of Centrally Stored Medication Records, and Medication Administration Records, there is no evidence to prove or disprove that staff are providing wrong medications to residents. Therefore, the allegation is deemed 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 the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Continued on 9099-C Page 2

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: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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 3

Control Number 27-AS-20211012153023

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: 10/14/2021

NARRATIVE

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Continued from 9099 - Page 2

Regarding the allegation Facility does not order medications timely. Based on LPA's interviews, review of Centrally Stored Medication Records, and Medication Administration Records, there is no evidence to prove or disprove that facility does not order medications timely. Therefore, the allegation is deemed 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 the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation Staff speaks inappropriately to residents.. This allegation was substantiated on September 16, 2021. The facility was cited for personal rights for staff speaking to residents inappropriately. During today's visit to facility LPA's interviewed staff and all stated that since that day they have not witnessed any further personal rights being violated. Therefore, the allegation is deemed 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 the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with facility staff and a copy of this report along with appeal rights was provided.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
10/12/2021 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20211012153023

FACILITY NAME:	SONORA SENIOR LIVING		FACILITY NUMBER:	552700409
ADMINISTRATOR:	MICHAEL MALONEY		FACILITY TYPE:	740
ADDRESS:	18760 CHABROULLIAN LN		TELEPHONE:	(209) 984-5124
CITY:	JAMESTOWN	STATE: CA	ZIP CODE:	95327
CAPACITY:	90	CENSUS: 50	DATE:	10/14/2021
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Michael Maloney, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility is not paying bills

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPA'S) Sarah Hurt and Ruth Wallace arrived unnannounced to deliver finding on the above allegation. LPA's met with Administrator Michael Maloney and explained the purpose of todays visit.

Regarding the allegation Facility is not paying bills. Based on monthly food receipts provided to LPA's over $12,000.00 a month is being spent for residents, the allegation Facility is not paying bills was deemed UNFOUNDED. This agency has investigated the allegation noted above and have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. We have therefore, dismissed the complaint.

No deficiencies were cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with facility staff and a copy of this report was provided.

Unfounded

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: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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 3