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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006057
Report Date: 08/01/2024
Date Signed: 08/01/2024 12:21:06 PM

Document Has Been Signed on 08/01/2024 12:21 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SOLIVEN CARE HOMEFACILITY NUMBER:
306006057
ADMINISTRATOR/
DIRECTOR:		SOLIVEN, JOSELOLITOFACILITY TYPE:
740
ADDRESS:6710 SEQUOIA DR.TELEPHONE:
(714) 310-9293
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 5DATE:
08/01/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:52 AM
MET WITH:Joselolito Soliven-AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20240725145144. LPA was greeted and granted entry into the facility by Caregiver Maria Carmen Zuniga and explained the reason for the visit. Administrator (AD) Joselolito Soliven arrived shortly after.

During the course of the complaint investigation, LPA reviewed documents including the Licensing Information System (LIS) Facility Personnel Report Summary dated July 31, 2024. Per LIS Facility Personnel Report Summary S1 is not associated and/or cleared to work at the facility.

Licensee agrees to read the following regulation 87355(e)(1) Criminal Record Clearance and sign a statement of understanding and forward proof to LPA by 08/02/24.



Licensee to verify staff is associated and cleared on Guardian prior to their first day working, residing or volunteering at the facility.

A $500 Civil Penalty was issued.

Based on today's visit, a deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with AD and a copy was provided as well as Appeal Rights.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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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Document Has Been Signed on 08/01/2024 12:21 PM - It Cannot Be Edited


Created By: Alvaro Ramirez Jr. On 08/01/2024 at 11:01 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SOLIVEN CARE HOME
FACILITY NUMBER: 306006057

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/02/2024
Section Cited
CCR
87355(e)(1)

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87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.
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Administrator agrees to obtain a background clearance for S1 to work at the facility. Licensee agress to sent S1 to go get background clearance today. Licensee to provide proof of POC via email by POC due date.
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This requirement is not met as evidence by: Per LIS Facility Personnel Report Summary S1 is not associated and/or cleared to work, reside or volunteer at the facility.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sheila Santos
LICENSING EVALUATOR NAME:Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2024


LIC809 (FAS) - (06/04)
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