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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804139
Report Date: 12/07/2023
Date Signed: 12/07/2023 01:43:47 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
11/03/2023 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20231103114921
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: 19DATE:
12/07/2023
UNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Elizabeth Hall, AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not prevent residents from having access to hazardous chemicals
INVESTIGATION FINDINGS:
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On 12/7/2023, Licensing Program Analyst Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Program Assistant, Julia Coty & Administrator, Elizabeth Hall. LPA toured the facility, interviewed staff, reviewed facility records and made observations during the course of the investigation.

Staff did not prevent residents from having access to hazardous chemicals. Based a review of facility files and an interview with staff and Administrator, it was confirmed that client (C1) had acquired and ingested Fabuloso all-purpose cleaner resulting in medical attention. The cleaning supply item was found in C1’s bedroom without knowledge from staff. Administrator stated that the cleaner was from the facility’s supply inventory therefore the allegation is found to be substantiated.

Allegation, staff did not prevent residents from having access to hazardous chemicals is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Appeal Rights Given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 21-AS-20231103114921
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: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/08/2023
Section Cited
CCR
80087(g)
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Buildings and Grounds 80087(g) - Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This was not met as evidence by:**
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Administrator has implemented a cleaning supplies tracker/log for all staff to complete before and after client cleaning chores to ensure all cleaning item inventory is secured and accurate. In addition, staff must monitor clients at all times when using cleaning supplies. Cleaning log was provided to CCLD.
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Based on reported incident and interview Administrator, it was found that client, C1 had acquired and ingested Fabuloso cleaning solution while in the facility. This is an immediate health & safety risk to clients in care.
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Deficiency cleared at time of visit.
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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.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
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