486804139-10-31-2023-21-AS-KMOA-CXLPFV-20231115101723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804139
Report Date: 10/31/2023
Date Signed: 10/31/2023 04:51:19 PM

Unsubstantiated

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
09/22/2023 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20230922085341

FACILITY NAME:	SOLANO HOUSE		FACILITY NUMBER:	486804139
ADMINISTRATOR:	HALL, ELIZABETH		FACILITY TYPE:	735
ADDRESS:	2251,2261,& 2271 S WATNEY WAY		TELEPHONE:	(530) 758-2160
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	32	CENSUS: 18	DATE:	10/31/2023
		UNANNOUNCED	TIME BEGAN:	09:46 AM
MET WITH:	Elizabeth Hall, Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not prevent an altercation between residents
Staff are not onsite leaving residents unsupervised

INVESTIGATION FINDINGS:

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On 10/31/2023, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Administrator, Elizabeth Hall. LPA conducted a tour of the facility, reviewed staff files, reviewed facility surveillance footage, interviewed staff and made observations.

Complaint alleges staff did not prevent an altercation between residents. Based on a review of facility reported incidents, an altercation occurred on 9/16/2023 between clients (C1 & C2) where C2 had been assaulted by client C1 in the facility dining area. Based on interview with Administrator, an internal investigation was completed and found that the incident was unprovoked but was initiated by client C1. LPA reviewed video surveillance footage with Administrator and observed C1 immediately walk into the dining area a quickly proceed towards C2, leading to the altercation. One staff (S1) that was located in the kitchen with line of sight on the residents, respond to the altercation and was able to de-escalate the incident within approximately 12 seconds from initial confrontation.
Continued onto LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20230922085341

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: 10/31/2023

NARRATIVE

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Although occurred, staff S1 responded in a timely manner and was able resolve the altercation. Staff S1 attempted to contact additional staffing support but was unable to reach staff through radio walkie system. Additional staff arrived at approximately 3 1/2 minutes after the altercation was de-escalated but were unaware of the event. Based on a review of the facility Policies & Procedures in the "Staffing Ratio and Work Hours" section; it is indicated that a minimum of three Behavioral Health Technician (BHT) Staff are to be present from 10:00am - 8:00pm. Upon review of staffing schedule for the dates: 9/16/2023, 9/29/2023 & 10/31/2023, LPA found that the facility met their program requirements for staffing and supervision. Due to a lack of corroborating evidence and conflicting information, the allegation is found to be unsubstantiated.

Complaint alleges staff are not onsite leaving residents unsupervised. Based on a tour of the facility and LPA observations over multiple visits to the program (9/29/2023 & 10/31/2023), LPA observed a sufficient amount of staff present providing supervision for clients in care based on facility staffing ratio policy. LPA reviewed staff time sheets confirming which staff are present during program hours. LPA conducted interviews with several staff. Based on interviews with staff (S1, S3, S4 & S6) there was indication of a lack of overall staff supervision. However, LPA received conflicting statements regarding staff being observed to leave the facility premise and leaving clients unattended. In addition, LPA found staffing to be sufficient during visits in compliance with the facility staffing ratio policies. Due to a lack of corroborating evidence the allegation is found to be unsubstantiated.

Allegations, staff did not prevent an altercation between residents & staff are not onsite leaving residents unsupervised are UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies cited.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

LIC9099 (FAS) - (06/04)

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