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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803688
Report Date: 10/08/2024
Date Signed: 10/08/2024 11:54:30 AM


Document Has Been Signed on 10/08/2024 11:54 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: 2DATE:
10/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Sneh Prakash (Administrator/Licensee)TIME COMPLETED:
12:09 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Required – 1 Year inspection and met with Sneh Prakash, Administrator/Licensee. There are currently 2 residents, annual fees are current. Contact information was reviewed. There are no residents receiving hospice services.

LPA/Administrator toured the building and grounds, which was found to be clean and at a comfortable temperature. Residents rooms are furnished per regulation. The amount of fresh and non-perishable foods were within regulation. There is a sufficient amount of hygiene products and linens for residents in care. Water temperature measured at 110 degrees F, which are within regulation. All resident's bathrooms contained necessary grab bars and non-slip floors/mats. The fire extinguisher was charged and serviced January 2024. Smoke detectors and carbon monoxide detector were tested and operational. Medication was centrally stored, and observed locked in a cabinet located in living room. Facility's last fire/disaster drill was conducted on 09/01/2024. Toxins were observed inaccessible to residents in care.

LPA initiated file review of two resident's files and two staff files at 10am. All residents files have current medical assessment and care plans within the last 12 months as stated per regulation. Two out of two staff do not have required additional training hours. One out of two staff do not have CPR/1st aid certificates updated (technical violation was issued). Sneh Prakash's Administrator Certificate 6034507740 expires 04/23/2025. Medication and medication records were reviewed.

Administrator submitted copies of the following: Copy of liability insurance, LIC500- Personnel Report, LIC308- Designation of Responsibility and control of property.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Licensee and a copy of this report was given.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024
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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Document Has Been Signed on 10/08/2024 11:54 AM - It Cannot Be Edited

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: SOLANO QUALITY HOME CARE
FACILITY NUMBER: 486803688

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(b)(2)
Other Provisions
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's/Licensee observation, interview and record review, the licensee did not comply with the section cited above in two out of two staff do not have additional training 20 hours completed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2024
Plan of Correction
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Licensee agrees to have staff complete training and send to CCL with form LIC9098 by POC due date to clear deficiency.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024
LIC809 (FAS) - (06/04)
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