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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700392
Report Date: 06/17/2022
Date Signed: 06/17/2022 11:35:06 AM

Document Has Been Signed on 06/17/2022 11:35 AM - 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:SOL-SIERRAS, CAMINA FRICIAFACILITY TYPE:
735
ADDRESS:10064 SCHULER RANCH RDTELEPHONE:
(916) 513-7822
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 4CENSUS: 2DATE:
06/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Camina Sol-SierrasTIME COMPLETED:
12:00 PM
NARRATIVE
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A case management visit was conducted today by Tung Truong, Licensing Program Analyst (LPA). LPA met with the Administrator, Camina Sol-Sierras.

The purpose of the case management visit was to follow up on the 30-day eviction notice of Client (C1). Based on the 30-day eviction notice sent to Licensing, there was no signature of the Licensee . It was learned that the eviction notice was also sent to C1’s conservator without the Licensee’s signature. Administrator informed LPA that she will hold off on the 30 day notice for now.

The following deficiencies are cited. See LIC 809 D. Appeal rights provided.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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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Document Has Been Signed on 06/17/2022 11:35 AM - It Cannot Be Edited


Created By: Tung Truong On 06/17/2022 at 09:02 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SOLSIE, LLC
FACILITY NUMBER: 342700392

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2022
Section Cited
CCR
85068.5(c)

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85068.5(c) Eviction Procedures. The licensee shall set forth in the notice to quit the reasons for the eviction, with specific facts including the date, place, witnesses, and circumstances…
This requirement is not met as evidenced by:
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Licensee shall review Title 22 Regulations, Section 80068.5, Eviction Procedures and submit a written statement stating knowledge of, understanding of regulation Section 80068.5. POC due 6/24/22.
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Based on interviews and records review, the licensee did not sign on the 30-day eviction notice that was given to the client’s conservator. This posed a potential, Health, Safety or Personal Rights risk to clients in care.
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The Licensee shall provide in writting a statement that she is rescinding the letter.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME:Tung Truong
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2022


LIC809 (FAS) - (06/04)
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