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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803688
Report Date: 01/11/2024
Date Signed: 01/11/2024 10:55:57 AM


Document Has Been Signed on 01/11/2024 10:55 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:SOLANO QUALITY HOME CAREFACILITY NUMBER:
486803688
ADMINISTRATOR:PRAKASH, SNEH LATAFACILITY TYPE:
740
ADDRESS:266 DE SOTO DRIVETELEPHONE:
(707) 386-3600
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 3DATE:
01/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sneh Prakash, AdministratorTIME COMPLETED:
11:10 AM
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On 1/11/2024 Licensing Program Analyst (LPA) Tobola arrived unannounced and was greeted by Administrator, Sneh Prakash. The purpose of the visit is to follow up on the fire clearance inspection, plan of correction for previous deficiencies and a health & safety check.

There are currently 3 residents under the facility's care one of which is on hospice. The facility was previously in the process of a pending fire clearance inspection to retain resident (R1) that was diagnosed as bedridden. During visit LPA learned that resident (R1) had been hospitalized 12/19/2023 and had also pronounced deceased the same day 12/19/2023. LPA and Administrator discussed reporting requirements and technical violation issued.

No deficiency cited.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2024
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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