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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804139
Report Date: 04/25/2023
Date Signed: 04/25/2023 01:42:28 PM

Document Has Been Signed on 04/25/2023 01:42 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:2251,2261,& 2271 S WATNEY WAYTELEPHONE:
(530) 758-2160
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 32CENSUS: 8DATE:
04/25/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jessica StillmanTIME COMPLETED:
12:00 PM
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Licensing Program Analyst Leibert arrived unannounced for the purpose of following up on POC for deficiency issued on 4/14/2023 that involved medication errors and medication storage. Initially, POC was due on 4/18 but was extended by LPA so that a broader range of Administration could be involved in the development of the correction plan. LPA met with the Assistant Director and spoke with the training Coordinator. LPA verified that the facility management has provided proof of correction and development protocols designed to minimize medication errors in the future. Deficiencies are cleared, cleared POC letter issued.

Report left.
No citations issued.
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.

LIC809 (FAS) - (06/04)
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