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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 05/15/2022
Date Signed: 05/16/2022 07:11:58 AM


Document Has Been Signed on 05/16/2022 07:11 AM - 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: 63DATE:
05/15/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Ronnie Hernandez, Facility managerTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Bruce Jacobs arrived at the facility unannounced to conduct a Case Management Health Check visit. LPA met with Facility Manager/Lead Med Tech Ronnie Hernandez and explained the purpose of today's visit.

LPA toured the facility kitchen, pantry, bathrooms, and resident rooms, and outdoor areas. LPA arrived at the time of shift change and there were 7 caregivers and two med techs on-site, determined to be an adequate number of staff for the number of residents. There was also an activities person and office staff. Ronnie stated that the morning shift had 4 caregivers and a med tech and the same numbers on the schedule for the PM shift. LPA observed running warm water, electricity, LPA observed residents in their rooms watching television and having an activity in the activity room.

No deficiencies were cited Per Title 22 Regulations during this visit. LPA conducted an exit interview with Facility Manager and left a copy of this report at the facility.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce JacobsTELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2022
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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