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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480110069
Report Date: 11/01/2024
Date Signed: 11/01/2024 10:38:29 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/01/2024 10:38 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SOLANO DIVERSIFIED SERVICES, INC.FACILITY NUMBER:
480110069
ADMINISTRATOR/
DIRECTOR:		LOUIS CHIOFALOFACILITY TYPE:
775
ADDRESS:1761 BROADWAY, SUITE 135TELEPHONE:
(707) 552-0300
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 65CENSUS: 35DATE:
11/01/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Nick Paine (Program Manager)TIME VISIT/
INSPECTION COMPLETED:
10:53 AM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced for the purpose of conducting an Annual Continuation Case Management visit and met with Nick Paine (Program Manager). Day Program is open Monday through Friday 8am-2:30pm.

During this Case Management Annual Continuation, LPA reviewed ten participants and three staff files. All participants have individual service plans updated. Staff files do have current CPR/1st aid and training hours completed as stated per regulation. Medication and medication records were reviewed. Annual fees are current.

No deficiencies were cited during this annual continuation case management visit. Exit interview was conducted and a copy of this report was given to the Program Manager.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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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