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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700392
Report Date: 01/06/2023
Date Signed: 01/06/2023 01:59:46 PM

Document Has Been Signed on 01/06/2023 01:59 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:SOLSIE, LLCFACILITY NUMBER:
342700392
ADMINISTRATOR:MARK SIERRASFACILITY TYPE:
735
ADDRESS:10064 SCHULER RANCH RDTELEPHONE:
(916) 513-7822
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 4CENSUS: 4DATE:
01/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Mark and Camina SierrasTIME COMPLETED:
02:15 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
On 1/6/2023, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct a case management visit regarding an incident report submitted to the Department on 12/15/2022. LPA met with Mark and Camina Sierras and explained the purpose of the visit. There are currently 5 clients who reside at this facility.

The purpose of the case management visit was to follow up on a concern learned through an incident report. Per incident report, an altercation between client (C1) and (C2) occurred on 12/15/2022. During today’s visit, LPA conducted interviews Mark and Camina Sierras. It was learned that staff (S1) and (S2) were present at the time of the incident to intervene and redirected C1. Client (C3) who intervened to help staff S1 was punch on the face by C1. It was learned that C1 was upset due to C2’s behavior. EGPD was called but no report was filed as C1 has calmed down when EGPD arrived. C3 was advised by staff to not intervene next time and let staff handle it. Based on today’s visit, it was determined that there is sufficient staffing at the time of the incident.


No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes.
Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2023
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