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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390306599
Report Date: 07/19/2022
Date Signed: 07/22/2022 11:29:29 AM

Document Has Been Signed on 07/22/2022 11:29 AM - 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:SOLIDUM GUEST HOME IIIFACILITY NUMBER:
390306599
ADMINISTRATOR:SOLIDUM, NORMA GFACILITY TYPE:
735
ADDRESS:3139 APPLING CIRCLETELEPHONE:
(209) 952-9126
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 6CENSUS: 6DATE:
07/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lynn Caoli, AdministratorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) R. Campbell conducted an unannounced Annual 1-Year Required visit on this date. LPA met and toured with Administrator, Lynn Caioli. The administrator currently holds a certificate (#6001906735) that expires on 12/04/2022.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of a total 6 bedrooms of which 4 bedrooms are occupied by the clients and 2 bedrooms are occupied by staff. All indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 112 degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients but secured.. There is a minimum of 7-day nonperishables and 2-day perishables of foods.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on April 22, 2022. Emergency Disaster Plan was last posted on 06/17/2022. First aid kit was observed to be complete. Fire drill was last conducted on July 02, 2022.

Staff records were reviewed, and all staff have criminal record clearance or a criminal record exemption and holds a current first aid certificate.

Excess items and detritus was in the backyard but pathways are clear.

No deficiencies were cited during this inspection.

Exit interview conducted. Appeal Rights and a copy of this report provided
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2022
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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