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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801928
Report Date: 01/12/2024
Date Signed: 01/12/2024 02:56:26 PM


Document Has Been Signed on 01/12/2024 02:56 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 LIFE HOUSEFACILITY NUMBER:
486801928
ADMINISTRATOR:FELIX, MARY E.FACILITY TYPE:
740
ADDRESS:575 S JEFFERSON ST.TELEPHONE:
(707) 678-1651
CITY:DIXONSTATE: CAZIP CODE:
95620
CAPACITY:38CENSUS: DATE:
01/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Mary Felix, AdministratorTIME COMPLETED:
03:00 PM
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At approximately 9:15 AM on 1/12/2024, Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual One-Year Inspection. At the time of arrival there were two (2) carestaff, (1) medication technician, one (1) cook, one (1) housekeeper and (1) Activities Director, in addition to the Administrator. There are 23 residents.

The Entrance at the front door has a Visitors' Log for visitors to answer screening questions, take their temperature and sign in. The Administrator, Mary Felix provided LPA with a a tour of the facility. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. All residents' bedrooms, common areas, kitchen & food storage areas were inspected. 5 Fire Extinguishers were found to be serviced on 04/11/2023 and were fully charged at the time of the visit. There was a central sprinkler system throughout the facility, which was inspected by Fire Code Safety Equipment on 12/06/23. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food in kitchen refrigerator was properly stored as per regulations on this day at the time of the visit. Hazardous items were stored inaccessible and locked to residents. There was a supply of cleaners, hygiene products and paper products which were stored and locked in the laundry room. All residents' bedrooms have lighting & appropriate furnishings. There were abundant activities taking place throughout the day taking the special needs of each resident into account.

There were no deficiencies. No citations issued during this inspection.

Exit interview was conducted with Administrator, Mary Felix.

SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2024
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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