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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800885
Report Date: 07/06/2023
Date Signed: 07/06/2023 11:55:40 AM

Document Has Been Signed on 07/06/2023 11:55 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:ARC-SOLANO, THEFACILITY NUMBER:
486800885
ADMINISTRATOR:STACEY MARTINEZFACILITY TYPE:
775
ADDRESS:3272 SONOMA BLVD #4TELEPHONE:
(707) 552-2935
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 30CENSUS: 24DATE:
07/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Stacey Martinez, DirectorTIME COMPLETED:
12:10 PM
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On 7/6/2023, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Inspection for this facility and met with Program Coordinator, Tamara Huizen and Director of Services, Marianita Vieira and Executive Director, Stacey Martinez. The facility is licensed by Alternatives In Curriculum & Training and currently serves 24 clients, 18 of which were at the facility at the time of visit. The facility is currently conducting full service program in which clients attend Monday through Friday. All online class options have ended and have transitioned fully back to in-person program. Clients appear to be engaged in group activities with proper social distancing in place. Clients currently provide their own meals with additional foods and snacks readily available. Sharps are all stored in a locked cabinet located in the kitchen. Toxins and cleaning supplies are stored in a designated cleaning locker and cleaning supply room inaccessible to clients.

LPA arrived at the facility and had temperature and symptoms checked and logged at the main entrance. LPA continued with a tour of the facility with Executive Director; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility staff measure water temperature at faucets accessible to clients in kitchen and restrooms on a regular basis and is recorded. Fire Extinguishers were found to be last charged on 4/12/2022 and are in need of inspection/recharge. Executive Director will be contacting Fire Marshall and provide photo corrections of updated fire extinguisher tags to CCLD. Technical Violation issued. Fire alarm, smoke detector and carbon monoxide detectors are interconnected and last inspected by the Bay Alarm Company on 3/2/2023.

LPA conducted a sample review of staff files and found all staff to have current 1st Aid & CPR certification and updated continuous annual training on file. In addition, LPA conducted a sample review of client files and found all ARC Individual Plans (Needs & Service Plans) to be current and client Physician's Reports to be on file. Facility is currently in the process of hiring additional instructor staff and was found to have a sufficient amount of staff providing care and course instruction to clients attending program.
Continued onto LIC809-C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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: ARC-SOLANO, THE
FACILITY NUMBER: 486800885
VISIT DATE: 07/06/2023
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LPA requested the following updated documents be sent to CCL by COB 8/6/2023:

LIC 308 Designated Facility Responsibility
LIC 500 Personnel Summary
LIC 610 Emergency Disaster Plan
LIC 9020 Register of Facility Client’s/Resident’s

No deficiencies cited during today's visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC809 (FAS) - (06/04)
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