486804139-4-5-2024-21-AS-KMOA-D48USX-20240411155105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804139
Report Date: 04/05/2024
Date Signed: 04/05/2024 03:28:03 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
02/08/2024 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20240208101703

FACILITY NAME:	SOLANO HOUSE		FACILITY NUMBER:	486804139
ADMINISTRATOR:	HALL, ELIZABETH		FACILITY TYPE:	735
ADDRESS:	2251,2261,& 2271 S WATNEY WAY		TELEPHONE:	(530) 758-2160
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	32	CENSUS: 21	DATE:	04/05/2024
		UNANNOUNCED	TIME BEGAN:	01:51 PM
MET WITH:	Kacy Goulart, Human Resources Director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 has violated clients’ personal rights. Upon interviews with multiple clients (C1,C2,C3,C4 & C5) as well as staff (S1 & S2), LPA’s received inconsistent and contradicting statements pertaining to personal rights. Due to a lack of corroborating evidence, the allegation is found to be unsubstantiated.
A finding that the complaint allegation, facility has violated clients’ personal rights is 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.

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)

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