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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 09/30/2022
Date Signed: 10/04/2022 07:06:19 PM


Document Has Been Signed on 10/04/2022 07:06 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: 60DATE:
09/30/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Human Resources Manager, Wonda WolskiTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit to the facility September 30, 2022 at 12:30 p.m for a POC visit. LPA met with and explained the purpose of the visit.

LPA Hurt observed the facility to have no Administrator as of today. The original citing "Administrator Qualifications" 87405(a) took place June 15, 2022. LPA Hurt will continue to assess civil penalties during this visit as the Plan of Correction has not been met.

Resident Care Coordinator Maranda Escobdedo has completed required training hours and is waiting for her testing date to become the certified facility Administrator.


Exit interview conducted with Human Resources Manager Wonda Wolski and a copy of this report left at the facility. .
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2022
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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