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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700643
Report Date: 12/13/2022
Date Signed: 12/13/2022 02:17:39 PM

Document Has Been Signed on 12/13/2022 02:17 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: 4DATE:
12/13/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Mark and Camina SierrasTIME COMPLETED:
02:40 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 12/13/22 at 1:30 pm, Licensing Program Analyst (LPA) Tung Truong arrived at the facility unannounced to conduct a quarterly health and safety check. LPA met with Mark and Camina Sierras and explain the purpose of the visit.

LPA toured and inspected the physical plant inside and outside to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in sanitary condition. LPA observed 2 day perishables and 7 day non-perishables food items. The hot water measured at 119.5 degrees Fahrenheit which is within the required range of 105-120*F. The temperature inside measured at 70 degrees Fahrenheit which is within the required range of 68-85*F. Smoke and carbon detectors were in good repair. Fire extinguisher and first aid kit was up to date. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed knives and toxins to be locked away and inaccessible to residents.

No deficiencies were cited, pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview held, copy of report given.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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