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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804139
Report Date: 04/25/2023
Date Signed: 04/25/2023 01:50:28 PM

Substantiated


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
04/20/2023 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20230420165733

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: 8DATE:
04/25/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jessica StillmanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility is not reporting incidents
Client records are not complete
Facility is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrived unannounced for the purpose of investigating this complaint. LPA toured facility, reviewed documents, interviewed staff and client. During the records review, 8 out of 8 client files reviewed contained no Needs and Service Plans as required by 850068.2. LPA determined that 2 recent incidents were not reported to CCL as required by 80061: On or about 3/23/23 a client's room was flooded when a shower backed up which necessitated calling the county for assistance; the building was evacuated and repairs are expected to take 2 more weeks and the building is currently a construction site; On 4/04/2023 at 9:41am, C1 left the facility and remained away for several hours; C1 did not accept calls from staff who made a referral to the crisis stabilization Unit due to concern for C1; Law enforcement was called a 3:41pm and a missing persons report was filed; C1 returned at 4:45 pm with a bag of what appeared to be marijuana and was confirmed by C1; During tour, LPA noted that the front door to Admin building would not open from the outside; staff stated that it was not properly functioning for "some time;" Door is a fire exit but five other fire exits are operable. Based upon statements, record reviews, and inspection, the preponderance of evidence standard has been met. Therefore, the allegations are SUBSTANTIATED. .....Continued next page......
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
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 4
Control Number 21-AS-20230420165733
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: 04/25/2023
NARRATIVE
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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.

REPORT LEFT

SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20230420165733
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: 04/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/02/2023
Section Cited
CCR
80061(b)(1)(E)
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80061 REPORTING REQUIREMENTS. Each licensee shall furnish reports....Any unusual incident or client absence which threatens the physical or emotional health or safety of any client. ***based on records and statements, this requirement not met as evidenced by: Licensee did not report client AWOL/Missing Person and did not
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Administration to review the requirements of 80061 and submit a written, signed declaration to CCL which attests to the facility's commitment to follow the requirements going forward. To be submitted to CCL by POC date in order to clear the deficiency.
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report flooded room requiring evacuation of building. This posed a potential risk to the safety of the clients in care.
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Type B
05/09/2023
Section Cited
CCR
85068.2(b)
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NEEDS AND SERVICE PLAN. ... prior to admission, the licensee shall complete a written Needs and Services Plan.....Based on file reviews, this requirement not met as evidenced by: 8 of 8 files contained no Needs and Service plans. This posed a potential risk to the health and safety of clients in care.
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Administration to complete needs and service plans for all clients in care and submit proof to CCL by POC date in order to clear the deficiency.
Type B
05/09/2023
Section Cited
CCR
80087(a)
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BUILDINGS AND GROUNDS.The facility shall be... in good repair at all times for the safety and well-being of clients, employees and visitors. ***based on inspection, this requirement not met as evidenced by: Front door to Admin Building not operable. This poses a potential risk to the safety of clients in care
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Administration to submit proof of correction to CCL by POC date in order to clear the deficiency.
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: 04/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4