552700409-2-23-2021-27-AS-KHOS-BYHRJ3-20210223120313

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 552700409
Report Date: 02/19/2021
Date Signed: 02/23/2021 12:00:30 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
06/15/2020 and conducted by Evaluator Kevin Gould

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200615104958

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:	02/19/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator, Katryna Hunt		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Neglect/Lack of Supervision:
1) Facility staff allow resident to smoke in non-designated smoking areas.
2) Resident's hygiene needs are not being met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Gould made an unannounced tele-inspection to the Sonora Senior Living Group Home on 2/19/21 at 4:00pm to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details.

Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated. During the investigation four staff members and four residents were interviewed (see confidential names list, LIC 811 dated 2/19/21). Staff interviewed could not identify any specific residents who are regularly skipped for bathing by staff members. S1 and S2 both stated that residents may refuse to shower but often are asked at a later time or by a preferred staff and the resident will accept. S3 stated sometimes showers can be missed but was unable to provide specifics including dates or residents that my not be attended to. LPA Gould also interviewed 4 residents. All residents denied that staff do not assist them with showering on designated shower dates.
Report Continued on LIC-9099C, Page 1 of 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2021

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 2

Control Number 27-AS-20200615104958

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: 02/19/2021

NARRATIVE

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All residents interviewed denied any complaints from other residents regarding bathing schedules. LPA was unable to interview R1 as he had passed prior to interview.

LPA Gould interviewed staff and residents regarding allegations of residents smoking in the facility. All staff and residents denied that staff allowed residents to moke inside the facility. LPA Gould interviewed two identified smokes in the facility (R2, R3) and both denied staff allow residents to smoke inside and both denied ever smoking inside. R2 and R3 identified R1 as a former resident who attempted to smoke inside. both residents stated staff addressed the issue with R1 and it was a one time occurrence due failing health of R1. All staff interviews corroborated the statements of R2 and R3 and denied that staff were allowing residents to smoke inside the facility. LPA was unable to interview R1 as he passed prior to interview.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of neglect/lack of supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22.

Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was mailed to the facility for signature

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SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2