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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 10/13/2022
Date Signed: 10/14/2022 01:09:35 PM


Document Has Been Signed on 10/14/2022 01:09 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: 65DATE:
10/13/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Human Resources Manager, Wanda WolskiTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit to the facility October 13, 2022 at 11:30 a.m. for a Case Management - Health Checks visit. LPA Hurt met with facility Resident Care Coordinator Maranda Escobedo and explained the purpose of the visit.

LPA toured the facility in part to include lobby, kitchen, dining room, Fireside Lounge, Assisted Living (AL) area, bathrooms and common areas.

LPA observed sufficient perishable and Non-perishable food supply. LPA observed 4 Caregivers, and one medication technician present assisting residents. LPA observed the kitchen staff making chicken breast, and scalloped potatoes, green beans, and an apple crisp dessert for the residents lunch meal. LPA observed facility staff serving the residents their lunch meal. LPA observed hot running water, and electricity in the facility.

No deficiencies cited today per Title 22 Regulations.

Exit interview conducted with Resident Care Coordinator, Maranda Escobedo and a copy of this report along with appeals rights left at the facility.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2022
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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