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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804139
Report Date: 04/05/2024
Date Signed: 04/05/2024 03:14:08 PM

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
01/10/2024 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20240110165734
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: 21DATE:
04/05/2024
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Kacy Goulart, Human Resources DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility staff do not safeguard residents' personal belongings
Residents' needs are not being met
INVESTIGATION FINDINGS:
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On 4/5/2024, Licensing Program Analysts (LPA’s) Tobola and Mutialu arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Human Resources Director, Kacy Goulart. LPA’s Tobola, Matialu and Leibert toured the facility, interviewed staff and clients, reviewed records and made observations during the course of the investigation.

Complaint alleges facility staff do not safeguard residents’ personal belongings. Based on interview with (S1), LPA’s were informed that an incident occurred involving a staff member potentially throwing away client personal food belongings without clients’ consent but was not confirmed. Upon interviews with client (C1, C2, C3, C4 & C5) LPA’s received inconsistencies with statements. Due to contradicting information and a lack of corroborating evidence, the allegation is found to be unsubstantiated.

Continued onto LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
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 2
Control Number 21-AS-20240110165734
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
VISIT DATE: 04/05/2024
NARRATIVE
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Complaint alleges residents’ needs are not being met. Upon interviews with multiple clients (C1, C3, C4 & C5), there were no indications that needs were not being met. In addition, clients’ statements indicated satisfaction in the services and programs provided by the facility. Due to contradicting information provided and a lack of corroborating evidence, the allegation is found to be unsubstantiated.

A finding that the complaint allegations, facility staff do not safeguard residents’ personal belongings and residents’ needs are not being met are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.



No deficiency cited.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2