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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397000618
Report Date: 07/19/2024
Date Signed: 07/19/2024 11:31:32 AM

Document Has Been Signed on 07/19/2024 11:31 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SOLIDUM CARE HOME #8FACILITY NUMBER:
397000618
ADMINISTRATOR/
DIRECTOR:
NORMA SOLIDUMFACILITY TYPE:
735
ADDRESS:217 BERNICE AVENUETELEPHONE:
(209) 477-2413
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 6CENSUS: 5DATE:
07/19/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Fhermezolie Cabutate TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 7-19-24 at 9:30am, Licensing Program Analyst (LPA) Michael Bilger and Licensing Program Manager (LPM) Liza King arrived unannounced to conduct a health and safety check visit. LPA met with Lead Caregiver Fhermezolie Cabutate and explained the purpose of the visit. LPA inspected physical plant including dining area, resident bedrooms, kitchen area, other common areas and outside of facility to ensure compliance with Title 22 regulations. During today's visit, LPA and LPM inspected resident files and staff training records. Additionally, LPA reviewed resident care log sheets and licensee audit sheets

Facility was observed to be clean and sanitary throughout with no foul odors. No stains were noted on walls or floors. Food storage was appropriate with adequate amounts of food available for residents. No obstructions to fire exits noted. All rooms contained required furniture and furnishings. A review of resident care log sheets revealed consistent records for each residents' hygiene, bathing and other activities of daily living (ADLs). LPA also observed licensee audit sheets to ensure completion of ADLs. Additionally, LPA reviewed 4 resident files. Staff training records were reviewed for completeness and included residential care facility for the elderly (RCFE) annual training requirements. LPA requested an updated LIC 308 and LIC 500 during today's visit.

As a result of today's visit, no citations are issued. An exit interview was conducted with Fhermezolie Cabutate and a copy of this report was provided to Norma.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2024
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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