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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804139
Report Date: 01/31/2024
Date Signed: 01/31/2024 05:09:17 PM


Document Has Been Signed on 01/31/2024 05:09 PM - 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 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: 22DATE:
01/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:31 PM
MET WITH:Elizabeth Hall, AdministratorTIME COMPLETED:
05:15 PM
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On 1/31/2024, Licensing Program Analyst, Tobola arrived unannounced for the purpose of following up on an incident reported to the department by the facility and was greeted by Administrator, Elizabeth Hall. The incident involved a client (C1) demonstrating aggressive acts and verbal threats towards a staff member. LPA interviewed Administrator and found that the incident occurred after C1 had become agitated during mealtime regarding food selection. C1 had verbally threatened the life of staff and knocked items off of the counter onto the floor. Staff who were involved in the incident were not present during the visit.

LPA was informed that C1 is currently transferred to a medical clinic with intention to relocate C1 to a more appropriate level of care.

No deficiencies cited.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024
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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