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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390306599
Report Date: 06/28/2023
Date Signed: 06/28/2023 01:19:45 PM

Document Has Been Signed on 06/28/2023 01:19 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: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:
06/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Lynn Caioli - AdministratorTIME COMPLETED:
02:00 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
Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Annual 1 Year Required visit. LPA met with administrator and explained purpose of visit. Administrator certificate expires on December 4, 2024.

LPA and administrator toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of a total six bedrooms of which four bedrooms are occupied by the clients and two 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 73 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 109.3 degrees 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 days of seven non-perishables and two day perishables of foods.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on May 1, 2023. Emergency Disaster Plan was last posted on 06/17/2022. First aid kit was observed to be complete. Fire drill was last conducted on June 4, 2023.

LPA reviewed three resident and three staff files, including criminal record clearances. All staff are fingerprint cleared and associated to the facility. First aid kit was checked and is complete.

LPA received updated copies of the documents:
LIC 308 - Designation of Administrator, Surety Bond, and Administrator Certificate

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies. Exit interview conducted with administrator and copy of report provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2023
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