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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804139
Report Date: 03/06/2025
Date Signed: 03/06/2025 03:13:08 PM

Document Has Been Signed on 03/06/2025 03:13 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SOLANO HOUSEFACILITY NUMBER:
486804139
ADMINISTRATOR/
DIRECTOR:		COUNTA, WENDIFACILITY TYPE:
735
ADDRESS:2251,2261,& 2271 S WATNEY WAYTELEPHONE:
(707) 920-2831
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 32CENSUS: 26DATE:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Wendi Counta, DirectorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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At approximately 9:50 AM Licensing Program Analyst (LPA) Robert Frank conducted an unannounced Annual Inspection for this facility and was greeted by Associate Director (AD) Shemariah Lewis. Director Wendi Counta arrived at 12:15 PM. Solano House is an Adult Residential Facility (ARF) licensed to service thirty-two (32) ambulatory clients between the ages of eighteen (18) and fifty-nine (59). At the time of the inspection the facility had twenty-six (26) clients. The facility consists of 3 buildings. Two (2) of the buildings are used for client housing. One (1) building is administrative and includes the kitchen and dinning room. There are outside walkways, a basketball court and recreational areas for clients to use. At approximately 10:30 AM LPA reviewed Facility Staff Roster and found that all staff members on site were background cleared and associated to the facility per regulation.

At approximately 10:40 AM LPA toured the facility with AD Lewis. The facility was observed to be clean, orderly, and at a comfortable temperature during today's visit. All common areas, hallways, and bathrooms observed by the LPA had sufficient lighting. Bathrooms observed had grab bars, and non-slip mat/flooring for bathing/showering as needed. The facility has emergency supplies, including food and water to meet requirements of the 72-hour shelter in place. The kitchen was observed to have a sufficient supply of perishable and non-perishable food. The dinning room had many snack options available to clients twenty-four (24) hours a day. Facility has a sufficient supply of cleaners, hygiene items, PPE supply, and paper products. All toxins/cleaners were locked and inaccessible to clients in care. Hot water temperatures for a sample size of five (5) sinks were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit.

Facility's smoke and carbon monoxide detectors and sprinkler system were last inspected 2/2025. All exits were observed to be unobstructed. All fire extinguishers were serviced and tagged 5/2024. The facility completes fire/emergency drills quarterly. The last disaster drill was held on 2/2025.
Continued on 809-C...
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SOLANO HOUSE
FACILITY NUMBER: 486804139
VISIT DATE: 03/06/2025
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...Continued from 809

LPA conducted a sample file review of five (5) staff members. All staff members had appropriate documentation, proof of training and current 1st Aid and CPR certification on file. LPA also conducted a sample file review for five (5) clients. Upon review, LPA observed that two (2) clients C1 and C2 to have Appraisal/Needs and Services Plans over one (1) year old. This deficiency will be cited. All other clients' files were observed to have appropriate documentation on file including current Service Plans and Physician's Reports. All medications were locked and inaccessible to clients in care. LPA conducted a spot check of five (5) clients’ medications and observed medications to be centrally stored and all documentation and medications to be in order. Personal and Incidental monies are kept by the clients.

Wendi Counta's Administrator Certification 6013654735 is current with an expiration date of 9/26/2026.

LPA is requesting the following documents submitted to CCLD by 4/6/2025:



LIC 500 Personnel Report
LIC 610D Emergency Disaster Plan

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to Director Counta. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/06/2025 03:13 PM - It Cannot Be Edited


Created By: Robert Frank On 03/06/2025 at 02:40 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SOLANO HOUSE
FACILITY NUMBER: 486804139

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80068.3(a)
Title 22, Division 6
Chapter 1
Article 06. Continuing Requirements
80068.3 Modifications to Needs and Services Plan

(a) The licensee shall ensure that each client's written Needs and Services Plan is updated as often as necessary to assure its accuracy, but at least annually. These modifications shall be maintained in the client's file.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that C1 and C2 did not have current Appraisal/Needs and Services Plan which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/27/2025
Plan of Correction
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Administrator will submit to Community Care Licensing updated Appraisal/Needs and Services Plan for Clients C1 and C2 by Plan of Correction (POC) due date of 3/27/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Victoria Bertozzi
LICENSING EVALUATOR NAME:Robert Frank
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
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