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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700392
Report Date: 09/10/2024
Date Signed: 09/10/2024 03:00:09 PM

Document Has Been Signed on 09/10/2024 03:00 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SOLSIE, LLCFACILITY NUMBER:
342700392
ADMINISTRATOR/
DIRECTOR:		MARK SIERRASFACILITY TYPE:
735
ADDRESS:10064 SCHULER RANCH RDTELEPHONE:
(916) 513-7822
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 4CENSUS: 4DATE:
09/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Rebecca SolTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a case management visit to follow up on an incident report. LPA Valerio met with facility staff Rebecca Sol, and explained the purpose of the visit.

LPA Valerio received an incident report regarding an incident that occurred on 08/10/2024 between Staff 1 (S1), Resident 1 (R1), Resident 2 (R2), and Resident 3 (R3). During the incident R1 was talking to S1 about obtain R1’s money. Due to S1 being a new staff member at the time, S1 did not have access to client funds and directed R1 to ask the administrator. R1 started yelling and calling S1 names. R2 started arguing with R1 informing R1 not to use that specific language towards staff. While R2 and R1 were arguing, R3 got up without warning and started to hit R1 on R1’s ears and pushed R1. Staff were able to separate the residents, de-escalate the situation, and assess for any injuries. No injuries were noted. All responsible parties, Regional Center, and CCL were notified of the incident.

According to the Licensee, residents have access to their funds and it is locked inside a safe. Licensee stated four staff members, including the full-time staff have access to the code.

Per California Code of Regulations (CCR) – Title 22, no deficiencies were cited. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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