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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 12/08/2021
Date Signed: 12/09/2021 11:12:38 AM

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:MICHAEL MALONEYFACILITY TYPE:
740
ADDRESS:18760 CHABROULLIAN LNTELEPHONE:
(209) 984-5124
CITY:JAMESTOWNSTATE: CAZIP CODE:
95327
CAPACITY:90CENSUS: 60DATE:
12/08/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Michael MaloneyTIME COMPLETED:
03:00 PM
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A Non-Compliance Conference (NCC) was conducted on this day in the Sacramento South Regional Office via Microsoft Teams due to COVID 19 precautions. The purpose of this Non-Compliance Conference meeting was to follow up with the facility after an initial NCC was held on 5/20/2021. Present in the meeting was Regional Manager Krystall Moore, Licensing Program Manager (LPM) LPM Stephenie Doub, Licensing Program Analyst (LPA) Sarah Hurt, Licensee/Administrator Mike Maloney and Resident Care Coordinator Maranda Escobedo. The Non-Compliance Conference process was explained during this meeting to include the Administrative Process.
Since the last meeting on 5/20/2021, eight new complaints have been filed against the facility and fourteen Type A deficiencies have been cited. The facility was cited for the following issues Medical Assessments, Basic Services, Care of Persons with Dementia, Personal Rights, Personnel – Operations, Maintenance and Operation, Reporting Requirements and Acceptance and Retention Limitations,
Issues discussed during the meeting were:
· The amount of complaint's filed against this facility in the past 6 months.
· Personal rights of residents
· Supervision issues
· Incomplete records
· Pre-appraisals / Compatibility
· COVID testing prior to admission
· Medications not being administered per policy
· Not following resident care plans
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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
VISIT DATE: 12/08/2021
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During the meeting on 5/20/2021, the facility agreed to the following:
· The previous Executive Director/Administrator was terminated
· The Executive Director will be present at the facility 40 hours a week
· Submit LIC500 Personnel Summary for facility to include the Administrator presence for 40 hrs
· Submit LIC308 Designation of person(s) in charge in the absence of the Administrator
· Submit incontinence and body check forms created to observe changes in the residents and keep completed copies in the resident file 6/15/2021.
· Conduct re-appraisals for all residents for each facility by 6/15/2021 hiring more staff if necessary
· Continue provide supervision for those with wandering behaviors in accordance with their care plans.
· Submit proof of staff training in the areas of observation, incontinence, personal rights and AWOL by 6/15/2021.
· Conduct fire drills monthly and keep records of completion
· Increased monitoring
· Facility was agreeable to Technical Support Program (TSP)

During today’s meeting it was discussed that TSP engagement has been delayed but should be starting in January. The RO will continue to monitor the facilities progress with the support of TSP for an additional four months. The RO will continue increased monitoring and verify new admissions are being properly assessed for compatibility and files are complete upon admission. The Licensee was reminded to subscribe to receive PINs and to follow COVID guidance. The RO also provided the licensee with resources for vendors and discussed hiring of a consultant for additional support. The RO will revisit compliance in 6 months and begin the legal process if facility is not in compliance.

Completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager.



Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies were cited during this visit. An exit interview was conducted with Mike Maloney and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
LIC809 (FAS) - (06/04)
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