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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 10/21/2022
Date Signed: 10/21/2022 03:15:11 PM


Document Has Been Signed on 10/21/2022 03:15 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: 64DATE:
10/21/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Wanda WolskiTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Christina Valerio and LPM Stephen Richardson arrived at the facility unannounced to conduct a POC visit. LPA met with Wanda Wolski, and explained the purpose of the visit.
 
LPA Valerio observed the facility to have no Administrator as of today. The original citing "Administrator Qualifications" 87405(a) took place on June 15th, 2022. LPA Valerio will continue to assess civil penalties during the visit as the Plan of Correction has not been met.
 
An exit interview was held with Human Resources Manager, Wanda Wolski, and a copy of the report was left at the facility.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022
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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