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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800885
Report Date: 07/26/2024
Date Signed: 07/26/2024 05:11:45 PM

Document Has Been Signed on 07/26/2024 05:11 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:ARC-SOLANO, THEFACILITY NUMBER:
486800885
ADMINISTRATOR/
DIRECTOR:		STACEY MARTINEZFACILITY TYPE:
775
ADDRESS:3272 SONOMA BLVD #4TELEPHONE:
(707) 552-2935
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 30CENSUS: 0DATE:
07/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Stacey Martinez, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On 7/26/2024, Licensing Program Analyst (LPA) A. Canela arrived unannounced to conduct an Annual Required – 1 yr. Inspection for this Adult Day Program and met with Executive Director, Stacey Martinez. The facility serves 24 clients daily, with a capacity to go up to 30 clients at one time. At the time of the inspection, there were no participants present as they all leave early on Fridays. The Program is currently conducting full service program in which participants attend Monday through Friday. Participants bring their own meals and the program provides snacks. Sharps are all stored in locked cabinets. Toxins and cleaning supplies are stored in a designated cleaning locker and cleaning supply room inaccessible to clients. Cleaning supplies and Toxic substances shall not be stored near food or food preparation areas.

LPA toured 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 and were serviced today 7/26/2024, prior to LPAs arrival. Fire alarm, smoke detector and carbon monoxide detectors are interconnected and last inspected by Bay Alarm Company on 3/5 2024. Emergency drills are conducted by the facility and the last one recorded was conducted on 3/5/2024.

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 participant files and found all ARC Individual Plans (Needs & Service Plans) to be current.


Continued onto LIC809-C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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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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: 07/26/2024
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This facility houses other program/services, such as Tailored
Day Service and Independent Living Skills/Support Services (ILS). LPA went over requirements for staff to have proof of Finger print Clearance and association to ARC Solano and proof of negative Tuberculosis (-TB).
LPA explained that any clients for those programs may be subject to regulation requirements under ARC Solano. LPA requested info and will review.

LPA requested the following updated documents be sent to CCL by COB 8/26/2024:


LIC 500 Personnel Summary
Current Lease agreement
Description and Operation of other services housed at ARC Solano

The following was provided to LPA during inspection:
LIC 308 Designated Facility Responsibility
LIC 9020 Register of Facility Client’s/Resident’s
Copy of current Surety Bond
LIC 610 Emergency Disaster Plan- no changes to update

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

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
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