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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397000618
Report Date: 01/05/2024
Date Signed: 01/05/2024 12:33:18 PM

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
09/14/2023 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20230914092803
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:
01/05/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Lynn CaoliTIME COMPLETED:
11:37 AM
ALLEGATION(S):
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Staff failed to provide care resulting in hospitalization.
Staff did not meet resident's hygiene needs.
INVESTIGATION FINDINGS:
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On 1-5-24 at 10:45am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegations noted above. LPA met with Administrator Lynn Caoli and explained the purpose of the visit. During this investigation, the Department conducted interviews with 4 clients in care, Administrator, 4 staff members, and additional witnesses. The Department also reviewed facility file documentation including admission agreement, appraisal needs and service plan, individual program plan (IPP), functional capabilities assessment, home health documentation, physician’s report, medication log sheets, care notes, activities of daily living (ADL) documentation, and would care documentation all pertaining to resident1 (R1).
Allegation: Staff failed to provide care resulting in hospitalization. The Department conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was determined that on 9-7-23, R1 was taken to the emergency room for worsening leg edema, redness, and pain. On 9-8-23, R1 was admitted to the hospital for cellulitis of bilateral lower extremities requiring IV antibiotics. R1 had two bilateral pitting edemas, erythema, pain on right side, oozing indentation, and a maggot infestation on the right ankle. {Cont on LIC 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 27-AS-20230914092803
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 CARE HOME #8
FACILITY NUMBER: 397000618
VISIT DATE: 01/05/2024
NARRATIVE
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R1 was treated for infection and wounds, and a total of nine maggots were removed from R1’s right ankle. According to interviews and record reviews, R1’s wounds became worse over time. Additionally, witness interviews revealed R1’s bandages on 9-7-23 were described as "old, dingy, and covered in blood and puss", which indicated bandages were not changed in accordance with R1s care plan. Moreover, interviews revealed R1 was only bathed once or twice per week which is counter to R1’s care plan stating R1 was to be bathed at least every other day. R1 was hospitalized from 9-7-23 to 9-12-23. Record reviews revealed that the maggot infestation appeared chronic “and if daily bandage changes were being performed this would have been noticed at least the day before” hospitalization. Based on record reviews and interviews, it is determined that facility staff did not properly care for R1 which resulted in R1 being hospitalized for cellulitis worsening wounds, and maggot infestation. The preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.
Allegation: Staff did not meet resident hygiene needs. The Department conducted interviews and record reviews as noted above. Based on these interviews and record reviews, it was determined that R1 was bathed once or twice per week. R1 had a care plan in place which stated R1 was to be bathed at least every other day. Additionally, it was determined through record review and interviews that R1 was treated for cellulitis and maggot infestation during a hospitalization period between 9-7-23 and 9-12-23 due to bandages not properly changed and legs not properly bathed and cleaned. Facility’s care log sheet for personal hygiene and grooming indicates various hygiene performed consistently for R1, however, does not indicate bathing of R1’s legs. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.

Citations are issued under Title 22, Division 6 and noted on LIC 9099D. An immediate civil penalty in the amount of $500 is issued in addition to citation due to injury resulting from the violation. Failure to correct the deficiency may result in additional civil penalties. At the time of the complaint visit, the issuance of a Civil Penalty was still being determined and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code Section 1548(f)(1)(A). An exit interview was conducted with Lynn Caoli and a copy of this report was left with Lynn. LIC 811 provided. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20230914092803
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 CARE HOME #8
FACILITY NUMBER: 397000618
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/08/2024
Section Cited
CCR
80078(a)
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80078. Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by:
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Licensee will submit a plan to address residents needs. Plan to include a log sheet and audit by licensee to ensure care plans and other care procedures are properly followed. Plan to be submitted to LPA by POC due date.
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Based on record review and interview, Licensee did not ensure proper care for R1’s leg wounds which led to worsening conditions and hospitalization. This posed an immediate health and safety risk to residents in care.
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Type A
01/08/2024
Section Cited
CCR
85077(a)
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85077 Personal services. (a) Licensees shall provide necessary personal assistance and care, as indicated in the needs and services plan, with activities of daily living including but not limited to dressing, eating, and bathing. This requirement was not met as evidenced by:
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Licensee will submit a plan to ensure clients receive all necessary activities of daily living. Plan to be submitted to LPA by POC due date.

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Based on interview and record review, Licensee did not ensure proper bathing for R1 which led to hospitalization. This posed an immediate health and safety risk to residents in care.
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Licensee to read regulation 85077(a) and submit a signed declaration of understanding to LPA by POC due date.
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: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3