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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342700643
Report Date:
05/13/2024
Date Signed:
05/13/2024 02:08:39 PM
Document Has Been Signed on
05/13/2024 02:08 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 2 CAREHOME
FACILITY NUMBER:
342700643
ADMINISTRATOR/
DIRECTOR:
FRICIA SOL-SIERRAS,CAMINA
FACILITY TYPE:
735
ADDRESS:
5319 APPLEHURST WAY
TELEPHONE:
(209) 986-1914
CITY:
ELK GROVE
STATE:
CA
ZIP CODE:
95758
CAPACITY:
4
CENSUS:
4
DATE:
05/13/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:
Camina Sierras
TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit. LPA Moleski met with facility administrator Camina Sierras and explained the purpose of the visit.
LPA Moleski provided Sierras with a decision and order regarding two former employees (S1-S2). LPA Moleski ensured that S1 and S2 were not working at the facility. LPA Moleski observed that S3 and S4 were the only staff members present during this visit.
No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Sierras.
SUPERVISORS NAME
:
Stephen Richardson
LICENSING EVALUATOR NAME
:
Vincent Moleski
LICENSING EVALUATOR SIGNATURE
:
DATE:
05/13/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/13/2024
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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