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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804139
Report Date: 04/14/2023
Date Signed: 04/14/2023 10:19:43 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2023 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20230323102414
FACILITY NAME:SOLANO HOUSEFACILITY NUMBER:
486804139
ADMINISTRATOR:HALL, ELIZABETHFACILITY TYPE:
735
ADDRESS:2251,2261,& 2271 S WATNEY WAYTELEPHONE:
(530) 758-2160
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:32CENSUS: 7DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jessica StillmanTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff are not properly storing resident's files.
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint allegation. LPA met with Jessica Stillman and discussed the complaint. During the course of this investigation, this Department has interviewed witnesses; obtained and reviewed documents, as well as made unannounced site visits to the facility. The following determinations are made: Resident records are kept in an office file cabinet which can be secured with a lock; Client files were secured and locked during unannounced visits by LPA; staff report client files are not always locked in cabinet during the times staff are accessing the records but that the office door is always kept locked and clients are not permitted in the office; Office door was locked during all LPA visits; Regulations require that client files be kept confidential; No evidence suggesting client records were not kept confidential was found. Although the allegation may be true, based on statements and site visits, there is not a preponderance of evidence to prove the allegation is or, is not, true. Therefore, the allegation is UNSUBSTANTIATED.

Report left.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2023 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20230323102414

FACILITY NAME:SOLANO HOUSEFACILITY NUMBER:
486804139
ADMINISTRATOR:HALL, ELIZABETHFACILITY TYPE:
735
ADDRESS:2251,2261,& 2271 S WATNEY WAYTELEPHONE:
(530) 758-2160
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:32CENSUS: 7DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jessica StillmanTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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2
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9
Staff do not properly store medication
Medication has not been given according to Physician’s direction

INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA met with Jessica Stillman and discussed the allegations. During the course of this investigation, this Department has interviewed witnesses, obtained and reviewed documents and photographs, and made unannounced site visits to the facility. The following determinations are made: On or about 3/31/23 S1 observed client medications co-mingled in a container; Med error report of 4/2/23 indicates C2 was administered Nortriptyline at 8 am instead of at bedtime as physician directed; LPA observed on 4/7/23 that facility had no documentation that C1 was administered or refused Olanzapine on 4/6/23 as directed by physician. Based upon observations, photographs, and statements, the preponderance of evidence standard has been met. Therefore, the allegations are SUBSTANTIATED. The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20230323102414
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 HOUSE
FACILITY NUMBER: 486804139
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2023
Section Cited
CCR
80075(K)(5)
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80075(K)(5) Health Related services. The following requirements shall apply to medications which are centrally stored: Each client's medication shall be stored in its originally received container. ***Based on photographs and statements, this requirement has not been met as evidenced by: S1 observed medications co-
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 Administrations will review the requirements of 80075 and will provide a written plan that outlines in detail how the facility will insure compliance going forward. Plan to be submitted to CCL for approval by POC date in order to clear the deficiency.
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mingled in one container. This posed an immediate risk to the health of clients in care.
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Type A
04/18/2023
Section Cited
CCR
80075(b)(5)(B)
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80075(b)(5)(B) Health related Services. Once ordered by the physician the medication is given according to the physician's directions. ***Based on documents and statements, this requirement has not been met as evidenced by: Facility records document medication errors occurred on 4/6/23 and
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 Administrations will review the requirements of 80075 and will provide a written plan that outlines in detail how the facility will insure compliance going forward. Plan to be submitted to CCL for approval by POC date in order to clear the deficiency.
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on 4/2/23 when medication was given at the wrong time and when no documentation exists medication was administered or refused. This posed an immediate risk to the clients in care.
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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.
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3