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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700643
Report Date: 08/05/2022
Date Signed: 08/05/2022 04:53:37 PM


Document Has Been Signed on 08/05/2022 04:53 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 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: 3DATE:
08/05/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Camina Sierras, Licensee/AdministratorTIME COMPLETED:
10:30 AM
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A Non-Compliance Conference was held via Microsoft Teams on August 5, 2022 at 9:00 AM. The Department explained the purpose of this office meeting to the Licensee/Administrator of Solsie 2 Carehome. The following were in attendance: Lead Regional Manager Stephen Richardson, Licensing Program Manager (LPM) Czarrina Camilon-Lee, Licensing Program Analyst (LPA) Tung Truong, Facility Licensee/Administrator(s) Camina Sierras and Mark Sierras. Alta California Regional Center representative: Client Service Manager Rowena Lopez, Associate Client Services director Jennifer Bloom.

The purpose of today's conference is to discuss the facility non-compliance issues. The Non-Compliance Conference process was explained during this meeting to include the Administrative Process.

Since the facility was licensed, two Type A deficiencies have been cited. The facility was cited for the following issues: Responsibility for providing care and supervision, Personal Rights.

Issues discussed during the meeting were:
- The amount of complaint's filed against this facility since licensure.
- Personal rights of clients
- Supervision issues
- Awake staff in the nighttime

Report continued on 809-C

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/05/2022
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- Ensuring behavior plans are implemented
- Designate an administrator for SOLSIE LLC. The following documents will need to be submitted to CCL: LIC 200, LIC 308, Administrator Certificate, LIC 501
- Requested LIC 500 for both Solsie 2 Carehome and Solsie LLC.
- Plan are put place to ensure staff are aware of 24/7 supervision
- Increase monitoring from Licensing
- Recommended Licensee of Residential Technical Support Program (TSP)

The facility has stated they will do the following to achieve continued and substantial compliance:
- Increased monitoring
- Submit all required documents to change administrator
- Camina Sierras will be admin for Solsie 2
- Designate Mark Sierras as admin for Solsie LLC.
- Plan to monitor change in client’s behavior
- On-site orientation and refresher training for staff regarding 24/7 care and supervision
- Ensure there is an awake staff at all times
- Conduct unannounced visit during noc shift
- Staff to document on-going notes every 30 minutes.
- Ensure a device is in place for staff to communicate with Licensee/Administrator effectively

Completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager.
Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. An exit interview was conducted with Camina Sierras and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
LIC809 (FAS) - (06/04)
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