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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397000618
Report Date: 01/18/2024
Date Signed: 01/18/2024 04:59:03 PM

Document Has Been Signed on 01/18/2024 04:59 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:SOLIDUM CARE HOME #8FACILITY NUMBER:
397000618
ADMINISTRATOR:NORMA SOLIDUMFACILITY TYPE:
735
ADDRESS:217 BERNICE AVENUETELEPHONE:
(209) 477-2413
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 6CENSUS: 3DATE:
01/18/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Norma SolidumTIME COMPLETED:
04:00 PM
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A Non-Compliance Conference (NCC) was conducted on 1-18-24 in the Sacramento South Regional Office via Microsoft Teams. The purpose of this Non-Compliance Conference meeting was to follow up on previous citations issued to facility following a completed investigation regarding resident hospitalization due to staff’s lack of care and supervision. Present in the meeting was Regional Manager (RM) Stephanie Doub, Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Michael Bilger, Regional Center Representatives Katina Richinson, Katie Murphy, and Brian Bennett, Licensee Norma Solidum, Administrator Lynn Caoli, Fhermezolie Cabutaje, direct service provider (DSP), and Vivian Aranda, RN, facility nurse consultant. The Non-Compliance Conference process was explained during this meeting to include the Administrative Process.

On 1-5-2024, an investigation was concluded for the following allegations: (1) Staff failed to provide care resulting in hospitalization and (2) Staff did not meet resident’s hygiene needs. Both allegations were substantiated, and Licensee was cited for violating Sections 80078(a) Responsibility for Providing Care and Supervision and 85077 Personal Services. Additionally, Licensee was cited for Section 85064(j)(4) Administrator Qualifications and Duties for not ensuring a provision of services related to the above substantiated allegations.

Additional review of previous citations include Section 80022(e) Plan of Operation and Section 85069.4(c)(1) Acceptance and Retention Limitations cited on 5-12-23 due to retainment of clients 60 years of age and older and associated functional assessment forms not updated accordingly.

{Cont. on 809C}
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 CARE HOME #8
FACILITY NUMBER: 397000618
VISIT DATE: 01/18/2024
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Regional Manager, LPM, and LPA discussed with Licensee and Administrator the above citations and a corrective action plan to assist Licensee with maintaining compliance. During today’s meeting, nurse consultant noted that client1 (C1)’s skin condition was chronic and bandages would soak frequently. RM stated to licensee and nurse consultant that a plan of care was not in place to specifically address such condition. RM, LPM, and LPA discussed with Licensee the importance of documentation and communication with necessary parties for purposes of addressing an adequate plan of care for clients as facility is non-medical. RM, LPM, and LPA also discussed with licensee the importance of proper utilization of home health services. Additionally, Licensee was made aware of clients over the age of 60 and the necessary required training and forms necessary when caring for such clients. Health and Safety Code Section 1569.625(b)(1) and (c), Section 1569.626(a)(1) and (2), Section 1569.696(a)(1) and (2) and Title 22 Section 87411(c) were discussed and given to Licensee for reference in aiding towards compliance. Licensee was also made aware to update program design to reflect new care for elderly clients 60 years of age and older.

In addition, eviction procedures were discussed with Licensee. Licensee was made aware to contact LPA for further guidance should any evictions of clients be necessary in the future. Licensee was offered the Department’s Technical Support Program (TSP) for additional support but have deferred at this time pending additional visits by LPA.

During the meeting on 1/18/2024, the facility agreed to the following:

(1) Presence of Administrator present at least 40 hours per week, (2) An updated care log sheet for each client to include specific care needs identified in the needs and service plans and individual program plan (IPP), (3) Routine audits conducted by Licensee or designee to ensure care procedures and all activities of daily living are followed accordingly. (4) Licensee to submit an LIC 500 reflecting 40 hours of Administrator presence, and (5) Proof of completed annual training pertaining to elderly care.

{Cont. on 809C}

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 CARE HOME #8
FACILITY NUMBER: 397000618
VISIT DATE: 01/18/2024
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Licensee was made aware that the above is to be sent to LPA by 1-24-24.

Additionally, the Regional Office will continue with unannounced quarterly visits to monitor the above and overall regulatory compliance.

Licensee has been advised of the following: Completing the non-compliance conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Codes if such action is deemed necessary by the Regional Manager.


In the event that the Department determines that the licensee has violated the law/regulations or is inadequately implementing the approved plans, the Department, in its discretion, may seek formal legal action or other appropriate administrative action.

No citations issued during today’s meeting. An exit interview was conducted with Norma Solidum and a copy of this report was emailed to Norma with a request to return with signature.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
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