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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804139
Report Date: 02/13/2023
Date Signed: 02/13/2023 12:42:00 PM

Document Has Been Signed on 02/13/2023 12:42 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 S WATNEY WAYTELEPHONE:
(530) 758-2160
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 32CENSUS: 0DATE:
02/13/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Elizabeth HallTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Karina Canela conducted a Pre-licensing inspection on 02/13/2023. LPA met with Elizabeth Hall, who will be the Administrator when the facility is approved for licensure. Staff Kasey, Julia, and Travis were also present. The facility has a fire clearance approval from the City of Fairfield Fire Department for a total capacity of 32 ambulatory. The facility does not have approval from the City of Fairfield Fire Department to accept or retain non-ambulatory and/or bedridden clients. Facility will operate with a 24/7 staffing and Licensee will ensure sufficient staffing at all times to meet the needs of clients and day staff-client ratio of no less than one direct care staff to three such clients per regulation 85065.5(a)(2) and night supervision per regulation 85065.6(d). The applicant has not submitted any waivers at this time. The facility does not have approval to secure/lock the perimeter, if applicant wishes to do so they understand they must submit a waiver to Community Care Licensing and obtain approval from the Fire Department.

During today’s visit LPA observed the following items:
· Visitor sign-in binder
· Lockable separate cabinets for medications, toxins, and knives.
· All exits were unobstructed
· Building smoke detectors, which are interconnected, were tested & observed to be operational
· 16 Carbon monoxide detectors installed in each client bedroom unit (8 in building 2271; 8 in building 2251)
· Complete first aid kit, bathroom night-lights, and flashlights for emergency lighting
· Paper products and hygiene supplies available
· 7 Fire extinguishers charged and serviced 06/13/2022
· Required furnishings (bedframe, mattress, chair, nightstand, lighting, drawer space) in 16 of 16 resident bedrooms
· Administrator Certifications; required postings (Personal Rights, Emergency plan/numbers, sample weekly activity schedule, sample menu, and visitor policy).
Report continued on LIC809-C...
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/13/2023
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LPA observed the following corrections needed:
    · Facility signal system per regulation:
        85088 (f)(1)(A-C) Fixtures, Furniture, Equipment and Supplies
        (f) Facilities shall meet the following signal system requirements:
          (1) In all facilities with a licensed capacity of 16 or more clients, and all facilities having separate floors or separate buildings without full-time staff there shall be a signal system which has the ability to meet the following requirements:
            (A) Operation from each client's living unit.
            (B) Transmission of a visual and/or auditory signal to a central location, or production of an auditory signal at the client's living unit which is loud enough to summon staff.
            (C) Identification of the specific client's living unit from which the signal originates.
    · Supply of linens: blankets, bedspreads, top/bottom bed sheets, pillow cases, mattress pads, rubber sheeting, bath/hand towels, and washcloths
        85088 (c)(4)(A) Fixtures, Furniture, Equipment and Supplies
          (c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene.
            (4) Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom bed sheets; pillow cases; mattress pads; rubber or plastic sheeting, when necessary; and bath towels, hand towels and washcloths.
              (A) The quantity of linen provided shall permit changing the linen at least once each week or more often when necessary to ensure that clean linen is in use by clients at all times.
    · Shaded area for outdoor activity
        85087.2 Outdoor Activity Space
        (b) The outdoor activity area shall provide a shaded area, and shall be comfortable, and furnished for outdoor use.
    ***Pre-licensing is incomplete with corrections needed. Applicant to correct the items listed above. LPA will return on Thursday 02/16/2023 for a scheduled subsequent pre-licensing inspection to complete inspection.

    The Component III Orientation was completed during today's visit. LPA will submit the pre-licensing reports to Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status.

    SUPERVISORS NAME: Hope DeBenedetti
    LICENSING EVALUATOR NAME: Karina Canela
    LICENSING EVALUATOR SIGNATURE:

    		DATE: 02/13/2023
    I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
    FACILITY REPRESENTATIVE SIGNATURE:

    		DATE: 02/13/2023
    LIC809 (FAS) - (06/04)
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