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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 02/08/2022
Date Signed: 02/08/2022 04:56:25 PM

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:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator, Michael MaloneyTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA), Sarah Hurt arrived at this facility today 02/08/2022 at 03:00pm. LPA met with facility Administrator Michael Maloney. The purpose of today's inspection is to clear deficiencies cited on 02/07/2022. LPA observed facility did purchase more food supplies, but there is still insufficient supply to meet the 7 day non- perishable food supply requirements.

Based upon this inspection, the LPA observed the following:

*Deficiency cited under Title 22 Division 6 Regulation 87555(b)(26) has not been cleared. Licensee has not complied with the terms of the POC by POC due date.

Exit interview was conducted with Administrator Michael Maloney and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
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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