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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803638
Report Date: 04/28/2023
Date Signed: 04/28/2023 12:33:48 PM

Document Has Been Signed on 04/28/2023 12:33 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 SERVICESFACILITY NUMBER:
486803638
ADMINISTRATOR:CHIOFALO, LOUISFACILITY TYPE:
775
ADDRESS:1234 EMPIRE STREET 1401-1412TELEPHONE:
(707) 552-9443
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 30CENSUS: 10DATE:
04/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH: Marcelle McKinley, Program CoordinatorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Marcelle McKinley, Program Coordinator. There were 3 staff and 10 clients present at today's inspection.
Facility has a screening station at the entrance to the program with sign-in sheet and hand sanitizer. LPA conducted a walk-through of the facility and all exits were unobstructed. Water temperature measured 117.3 F, which is within regulation. All staff have CPR/first aid certifications. Fire inspection done on 4/11/2023 by city fire department. Fire extinguisher was recently purchased, receipt attached. There was one carbon monoxide detector in hallway, which was operational. Solano Diversified Services is currently providing in-person services Monday through Friday, as well as alternative services through Virtual Zoom classes (art, workouts, Spanish, Sign Language classes, coffee club, culture class, planning, driver's education, self-care class, trivia, etc). The clients in attendance were engaged and happy to be a part of the program.

LPA observed Infection prevention precautions were in place and soap & paper towels were available. Staff clean the facility daily. The facility does not handle client cash resources or medication. The facility has a supply of PPE. Infection Control Plan was submitted in June of 2022.

LPA requested the following updated forms to be submitted to Community Care Licensing:
Copy of current Lease/Rental Agreement or Property Tax document showing control of property.

No deficiencies were found at the time of inspection. No citations issued.

Exit interview conducted with Marcelle McKinley, whose signature on this document confirms receipt.,
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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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