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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480110069
Report Date: 11/20/2023
Date Signed: 11/20/2023 12:59:00 PM

Document Has Been Signed on 11/20/2023 12:59 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
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: 32DATE:
11/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Program Manager, Nick PaineTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Solano Diversified Services, Inc. for the purpose of conducting a Required 1 year inspection. LPA met with Program Manager, Nick Paine, and was granted access into the facility.

LPA and Program Manager toured the facility which was found to be clean, in good repair, at a comfortable temperature with exits free from obstruction. The facility consists of a kitchen, 2 bathrooms, 6 class rooms, a isolation area, and two staff offices. Bathrooms contained necessary grab bars, hygiene products and continence care products available for for client use. Hot water measured at 119 degrees F which is within Title 22 regulations of 105 to 120 degrees F in faucets used by clients. Participants typically bring their own lunches and snacks unless there is a party or special occasion. Should clients forget their lunch staff will purchase or prepare a lunch for them. All items that could constitute danger were found to be inaccessible at the time of the inspection. Fire extinguishers were observed to be present with an inspection tag date of December 2022. Smoke Detectors sound directly to the Fire Station. Carbon Dioxide Detectors were tested and found to be operational during the inspection. A sample review of 5 client and 5 staff records were conducted. LPA observed that 5 of 5 staff members did not have the required annual training (See LIC 9102-Technical Violation). LPA educated the Program Manager on the importance of ensuring that all staff members have the required annual training. Vehicle inspection and maintenance logs are maintained and were observed to be kept on a daily basis for all vehicles transporting clients. Staff and client interviews were conducted. First Aid Kit was inspected and found to be appropriate during the inspection. First Aid/CPR Cards were active for all staff members.

LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + or any other infectious diseases in the facility. (Report continued on LIC 809C)
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SOLANO DIVERSIFIED SERVICES, INC.
FACILITY NUMBER: 480110069
VISIT DATE: 11/20/2023
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LPA discussed the Emergency Disaster Plan with the Program Manager. Emergency disaster drill was last conducted in November 6, 2023. LPA requested the following documents:

LIC 500-Personnel Report
LIC 308-Designation of Responsibility
Liability insurance
Control of Property
Client Roster
Staff Roster
Infection Control Plan

No deficiencies were cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was given to the Program Manager.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
LIC809 (FAS) - (06/04)
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