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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480110069
Report Date: 12/14/2021
Date Signed: 12/14/2021 11:48:16 AM

Document Has Been Signed on 12/14/2021 11:48 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
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:SOLANO DIVERSIFIED SERVICES, INC.FACILITY NUMBER:
480110069
ADMINISTRATOR:LOUIS CHIOFALOFACILITY TYPE:
775
ADDRESS:1761 BROADWAY, SUITE 135TELEPHONE:
(707) 552-0300
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 65CENSUS: 46DATE:
12/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Ronda Reyes, Administrative ManagerTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and met with Administrative Manager, Ronda Reyes (RR) and Office Manager, Rosario Salvador (RS). The facility is licensed by Solano Developmental Services INC. and currently provide services for 46 clients; 24 clients participate in program Monday through Friday and 22 clients participate currently participate remotely. There were 21 clients in program attendance at the time of visit. Facility has contracted with R&D Transportation Services for client transportation.

LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with management staff, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire extinguisher was found to be last charged on 10/25/2021. In addition, Fire Inspection was last conducted in 3/2021 with Carbon Monoxide detector tested and found to be functional.

Infection Control:
Facility has submitted a mitigation program plan that has been approved. Posters are found throughout the facility for COVID protocols and practices. Facility has a station at main entrance with a sign in sheet in place, hand sanitizer and other items designated for clients and staff. Staff and clients are screened on a daily basis and recorded. Per management staff, clients bring individual lunches with snack available throughout the day. Facility has modified activities and transportation services to ensure social distance practices.

LPAs requested for facility updated records which will be send via email by COB 12/17/2021:
Emergency Disaster Plan
Transportation Procedures

No deficiencies cited during today's visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2021
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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