<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 552700409
Report Date: 10/27/2022
Date Signed: 10/27/2022 12:11:09 PM


Document Has Been Signed on 10/27/2022 12:11 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: 58DATE:
10/27/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Wanda Wolski, Maranda EscobedoTIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Christina Valerio and Licensing Program Manager (LPM) Stephen Richardson arrived unannounced to the facility to conduct a case management visit due to reports of an eviction being served. LPA met with Human Resource Manager (HRM), Wanda Wolski, and explained the purpose of the visit. LPA and LPM met with resident 1 on 10/21/2022.

On 10/21/22, LPA and LPM interviewed residents during today's visit. Based on interviews, 3 out of 4 residents enjoy today's meal. Lunch was crab cakes, broccoli slaw, tater tots, and a dessert. According to interviews with kitchen staff, staff stated that residents are more than welcome to ask for seconds. If a resident does not like or would like another option, residents are able to have leftovers from the previous day, a sandwich, or a snack item of what is available. According to interviews, the department was informed, that the facility issued an eviction notice to resident 10/20/22. Due to time constraints, the department will return at a later date.

On 10/27/22, LPA Valerio arrived to the facility unannounced to continue to the visit.
According to Resident Care Coordinator Maranda, an eviction notice was not given to resident 1 (R1). R1 was informed that if R1 is unhappy, R1 is allowed to relocate to other places in the area. Resident Care Coordinator stated an eviction notice has not been given to anyone except Resident 2. Resident Care Coordinator Maranda stated she is aware of the eviction procedures and will be working with R1 to ensure R1's needs are net.

Per California Code of Regulations (CCR),Title 22, Division 6, Chapter 8, no deficiencies will be cited based on these concerns. An exit interview was held with Resident Care Coordinator Maranda Escobedo.
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)
Page: 1 of 1