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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 09/02/2022
Date Signed: 09/13/2022 04:04:47 PM


Document Has Been Signed on 09/13/2022 04:04 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: 61DATE:
09/02/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Human Resources Manager, Wonda WolskiTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Sarah Hurt conducted a visit to the facility September 2, 2022 at 11:00 a.m.. for a Case Management - Health Checks visit. LPA Hurt met with facility Human Resources Manager, Wonda Wolski and explained the purpose of the visit.

LPA Hurt spoke with Human Resources Manager Wonda Wolski who stated she received a call around 9 p.m. on September 1, 2022 informing her of the mandatory evacuation of the facility. Wonda stated she arrived at the facility and ambulances were there preparing to evacuate residents. Wonda stated all night shift staff stayed at Avalon Care Center with the residents. Wanda stated she returned to the facility from Avalon Care Center to pour enough meds for all the residents. It is 11:30 a.m. and the mandatory evacuation is still in place.

LPA Hurt arrived at Avalon Care Center - Sonora and observed 60 Sonora Senior Living facility residents present. The Sonora Senior Living residents were in rooms or in the facilities dining area on fold out cots. LPA Hurt observed facility Medication Technician Ronnie Hernandez to be present at Avalon Care Center with the residents and all medications. LPA Hurt observed 6 caregivers, facility receptionist, dietary aide, cook, and activities staff at Avalon Care Center assisting with supervising residents.

Resident 1 is at the local hospital as he was injured in a resident on resident altercation. Resident 1 will be returned to Avalon and transported back to the facility when evacuation is lifted.

Local Ombudsman and Human Resources Manager Wonda Wolski called resident families to inform them of the evacuation.

No deficiencies cited per Title 22 Regulations. A copy of this report emailed to Resident Care Coordinator Maranda Escobedo.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2022
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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