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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700643
Report Date: 07/20/2022
Date Signed: 07/20/2022 03:03:01 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/22/2022 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20220222114943
FACILITY NAME:SOLSIE 2 CAREHOMEFACILITY NUMBER:
342700643
ADMINISTRATOR:FRICIA SOL-SIERRAS,CAMINAFACILITY TYPE:
735
ADDRESS:5319 APPLEHURST WAYTELEPHONE:
(209) 986-1914
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:4CENSUS: 4DATE:
07/20/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Camina SierrasTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Lack of supervision resulted in client being raped
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tung Truong arrived at the facility unannounced on 07/20/2022 at 2:00 pm to deliver the complaint findings. LPA met with Administrator Camina Sierras and explained the purpose of the visit.

The investigation was conducted by the Department which consisted of reviews of medical records, police report and interviews. Based on the interviews and records obtained during the investigation process, it was learned that client (C1) was raped and sexually assaulted by client (C2). According to police report, C2 admitted to raping and sexually assaulting C1. Medical records revealed C1’s sexual assault physical examination is consistent with C1’s report of sexual assault. Staff (S1) and (S2) admitted that they were asleep when incident occurred. Staff did not provide 24/7 care and supervision as stated in the Program Design which result in client C1 being raped and sexually assaulted.

Report continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 27-AS-20220222114943
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SOLSIE 2 CAREHOME
FACILITY NUMBER: 342700643
VISIT DATE: 07/20/2022
NARRATIVE
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As a result of this investigation, the Department finds the allegation above to be Substantiated. A finding that the complaint is Substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations.

At the time of this complaint visit, the issuance of a civil penalty was still being determined and the licensee was informed that a civil penalty might be assessed based on Health and Safety Code §1548.

Exit interview conducted with Administrator Camina Sierras. A copy of this report, LIC 9099-D, and appeal rights were provided.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20220222114943
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SOLSIE 2 CAREHOME
FACILITY NUMBER: 342700643
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/21/2022
Section Cited
CCR
80078(a)
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80078(a) Responsibility for providing care and supervision. The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement is not met as evidence by:
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Administrator/Licensee will provide an in-service training for all staff regarding care and supervision and submit a written statement stating knowledge of, understanding of the regulation 80078 to CCL by the POC due date of 7/21/2022.
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Based on interviews and records review, the licensee did not ensure that care and supervision was provided at all times. Staff did not provide 24/7 care and supervision which resulted in client C1 being raped and sexually assaulted by client C2. This poses an immediate health and safety risk to clients in care.
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Type A
07/21/2022
Section Cited
CCR
80072(a)(1)(2)
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80072 Personal Rights. Each client shall have personal rights which include...(1)To be accorded dignity in his/her personal relationships with staff and other persons. (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
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Administrator/Licensee will submit to LPA a statement of understanding regarding Personal Rights regulation 80072 and its requirements. Administrator/Licensee will also conduct an in-service training for staff regarding understanding of personal rights for client care. Administrator/Licensee will send a sign-in sheet with all staff signatures by POC due date 7/21/2022.
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Based on interviews and records review, the licensee did not ensure client C1 is accorded with dignity, safe and healthful accommodations. Client C1 was raped by another client while in care. This poses an immediate health and safety risk to clients in care.
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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.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC9099 (FAS) - (06/04)
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