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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 02/08/2022
Date Signed: 02/11/2022 11:53:03 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:
02/08/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator Michael MaloneyTIME COMPLETED:
03:00 PM
NARRATIVE
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An office meeting was held on this day in the Sacramento South Regional Office via Microsoft Teams due to COVID 19 precautions. The purpose of the meeting was to discuss recent complaints and financial concerns. Present at the meeting were Regional Manager (RM) Krystall Moore, RM Brenda White, Licensing Program Manager (LPM) Stephenie Doub, LPM See Moua, Centralized Applications Bureau Chief Hao Nguyen, Staff Service Manager Tracy Thompson and Darla Neeley, Licensing Program Analyst Sarah Hurt, Audit Manager Jacqueline Juarez, Ombudsman Melissa Flaherty and Jill Engle, Licensee Gina Rodriguez, Administrator Michael Maloney and Resident Care Coordinator Maranda Escobedo.

On 2/7/2021, a visit was made to the facility where it was found that there was not enough food to meet regulatory requirements. It was found that the facility was behind on payments to vendors including their fire alarm company. The RO also found that the LLC is delinquent with the franchise tax board, SYSCO food distribution, Sentry alarm company, and ECO incontinent care supply distribution company. The licensee was notified there now will be a Solvency audit performed on the facility to monitor finances. The Licensee was informed they will need to submit the documents requested below by March 8, 2022.

The documents required are as follows:


· LIC 401
· LIC 402
· Rent roll
· Utility statements
· Food receipts
· Monthly and quarterly bank statements

Continued on 9099C...
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 02/08/2022
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Continued from 9099...

The following items were also requested copies of all receipts for food for the past 2 weeks to be provided by 02/14/2022, a copy of the payment to Sentry Alarm company, a weekly menu to be provided to LPA every Monday. The Licensee was encouraged to reach out to the Department should there be any questions regarding receipts to submit. The Licensee was also notified by Regional Manager Krystal Moore that the facility will now be recommended for Administrative Action.

An exit interview was conducted with Administrator Michael Maloney a copy of this report was provided via email.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 02/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/11/2022
Section Cited

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87205 Accountability of Licensee Governing Body (a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves.
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This requirement has not been met as evidenced by: Based on records reviewed and LPA interviews the licensee is not ensuring the facility has sufficient food supply, care supplies, and fire clearance which poses an immediate health, safety or personal rights risk to residents in care.
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Type A
02/10/2022
Section Cited

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87202 Fire Clearance
(a)All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.
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This requirement has not been met as evidenced by: Based on records reviewed and LPA interviews the licensee is not paying the Sentry alarm company and the facility is at risk of losing fire clearance which poses an immediate health, safety or personal rights 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: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3