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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 05/03/2022
Date Signed: 05/03/2022 06:35:38 PM


Document Has Been Signed on 05/03/2022 06:35 PM - It Cannot Be Edited

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: 59DATE:
05/03/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Licensee Georgina RodriguezTIME COMPLETED:
03:30 PM
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An office meeting was conducted on this day in the Sacramento Regional Office via Microsoft Teams. The purpose of this meeting was to discuss payments to Sysco, the facilities food vendor, and ongoing concerns related to Supervisory roles and resident care and supervision. Present at the meeting was Regional Manager (RM) Krystall Moore, Licensing Program Manager (LPM) Stephenie Doub, Licensing Program Analyst (LPA) Sarah Hurt, Jacqueline Juarez, DSS Auditor manager, DSS Auditor Jorge Mojica, Licensee Georgina Rodriguez, Licensee Asok Kumar Mukhopadhyay, Attorney representing Licensee, and Resident Care Coordinator Maranda Escobedo

Regional Manager Krystal Moore expressed concerns with care and supervision at the facility as Licensing is still receiving reports of several concerning incidents at the facility. Regional Manager Krystal Moore discussed advance Sysco payments agreed upon by Licensee Georgina Rodriguez. The Licensee advised they are working out issues with Sysco automatic payment but plan on enrolling as soon as possible. The Licensee advised they are hiring a consulting company to assist with overseeing the facility.

The licensee agreed to the following:

· Submit a plan by tomorrow detailing the roles and responsibilities of Supervisory staff at the facility

· Submit a staff schedule and designate who is in charge for each shift

· Provide a detailed plan for resident continuing to display aggressive behaviors

· Proof of payment clearing to Sysco food distributor

An exit interview was conducted with Licensee Georgina Rodriguez. A copy was provided to Licensee and administrator via email. A confirmation read receipt confirms receipt of this report.

SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2022
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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