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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 390305107
Report Date: 02/14/2024
Date Signed: 02/14/2024 11:53:32 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2024 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240209162801
FACILITY NAME:SOLIDUM GUEST HOME 2FACILITY NUMBER:
390305107
ADMINISTRATOR:SOLIDUM NORMAFACILITY TYPE:
735
ADDRESS:3115 APPLING CIRCLETELEPHONE:
(209) 952-4276
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:6CENSUS: 6DATE:
02/14/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ricky EnriquezTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff placed client in the wrong transportation bus
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to open and deliver complaint findings for the above allegations. LPA was greeted by staff spoke to administrator on the phone. LPA explained the reason for the visit.

Based on documents reviewed, interviews with facility staff and administrator. The above allegation is SUBSTANTIATED A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. This poses a potential health, safety, and personal rights risk to residents in care.

California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099-D.

LPA exit review: 9099 , 9099-D and appeal rights given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 27-AS-20240209162801
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SOLIDUM GUEST HOME 2
FACILITY NUMBER: 390305107
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/16/2024
Section Cited
CCR
80078(a)(1)
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NEGLECT AND LACK OF SUPERVISION -(a) In addition to Section 80078, the following shall apply:
(a)(1) The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs.
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Licensee will provide LPA Lewis with an updated LIC 500 to show the is enough staff for the residents by COB 9/16/2023 and a plane on how this can be avoided in the future.
Kesha.lewis@dss.ca.gov
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As evidenced by interviews with S1, R1 was put on the wrong bus to day program by facility staff. This poses an imitate health, safety, and personal rights risk to residents 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: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
LIC9099 (FAS) - (06/04)
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