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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700643
Report Date: 05/18/2022
Date Signed: 05/18/2022 03:44:07 PM

Unsubstantiated


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 Anthony Tuck
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:
05/18/2022
UNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Camina Sol SierrasTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
staffing ratio not met
Care plan not followed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Anthony Tuck arrived at the facility on 05/18/2022 unannounced. LPA was met by Administrator Camina Sol Sierras. LPA explained the purpose of today's visit to conclude the complaint allegations listed above.

LPA conducted interviews with 3 staff. LPA learned that the facility has staff throughout the day and 2 staff who live at the facility. LPA learned that the facility has 1 staff on schedule who works the NOC shift (S2). LPA learned that another staff (S3) who lives at the facility will also be awake occasionally and assist S2 if needed during a NOC shift. LPA learned that S3 is not on schedule for NOC shift. LPA reviewed a copy of the (IPP) individual program plan for client (C1). LPA learned from interviews with staff that the IPP was followed and progress updates were provided to ALTA Regional SC on a quarterly basis for C1. LPA learned that S1 was the main staff who was able to motivate C1 to complete his daily activities and reach his quarterly goals.
continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Anthony Tuck
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
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 2
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: 05/18/2022
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
26
27
28
29
30
31
32
LPA was not able to obtain any statements from C1 during the investigation period after multiple phone call attempts.

Based upon interviews and documentation obtained, there is not substantial evidence to support or disprove that the alleged violations occurred. Due to the preponderance of evidence standard not being met by the department standard. There is no physical evidence to support the validity of the allegations as well as witness statements; LPA has deemed the complaint findings as UNSUBSTANTIATED. Although the allegations may have happened and/or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted with Camina Sol Sierras, a copy of this report was left with the facility upon exit.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Anthony Tuck
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2