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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804139
Report Date: 10/08/2024
Date Signed: 10/08/2024 02:06:41 PM

Document Has Been Signed on 10/08/2024 02:06 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/
DIRECTOR:		HALL, ELIZABETHFACILITY TYPE:
735
ADDRESS:2251,2261,& 2271 S WATNEY WAYTELEPHONE:
(530) 758-2160
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 32CENSUS: 23DATE:
10/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Wendi Counta, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
02:21 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a case management inspection and met with Wendi Counta, Program Director. The visit is due to an incident regarding a medication error submitted to Community Care Licensing (CCL) on 10/4/24.

Per incident report, on 9/25/24 at approximate 6:49pm, Program Director was notified by staff (S1) that client (C1) was out of medication Risperidone 1mg since 9/18/24. S1 called C1's psychiatrist to get a refill of the medication. Apparently, staff (S2) that was responsible for this incident was told the psychiatrist was on vacation, so they assumed that they were not able to get a refill, the facility have process to follow regarding this type of incidents, but S2 did not follow them. Upon discover of the incident, Program Director met with S2 to give them a corrective action including a zero tolerance policy that will result in termination of employment if any further incident occurs. Additional training was provided to S2 and scheduled for regular check-ins to ensure that this type of incidents do not happen again. All medication technician staff have been notified about updated ordering and tracking of medications process, which consists in additional steps to the already implemented system of emailing program director every morning with medications that need to be refilled. Additionally, med-tech need to copy in their emails to other med-techs that helps with ordering medications anytime any resident is seven days away from a refill that it is not automatic.

Continues on LIC809C...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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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Document Has Been Signed on 10/08/2024 02:06 PM - It Cannot Be Edited


Created By: Marisol Cuadra On 10/08/2024 at 01:50 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: 10/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/25/2024
Section Cited
CCR
80075(b)(5)(B)

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80075(b)(5)(b) Health Related Services:
(b) Clients shall be assisted as needed with self-administration of prescription & nonprescription medications. (5)..., providing all of the following requirements are met: (B) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by:
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Program Director submitted proof of additional training for medication with staff to ensure future compliance. Program Director will submit a self-certification form LIC9098 ensuring that all staff have received additional training by POC due date to clear the citation.
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Based on observations, interviews with Program Director and records review of facility records, facility staff did not ensure that C1 was assisted with prescribed medication Risperidone 1mg since 9/18/24 to 9/25/24. This poses an immediate health, safety and personal rights risk to clients in care.
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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:Bethany Moellers
LICENSING EVALUATOR NAME:Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024


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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SOLANO HOUSE
FACILITY NUMBER: 486804139
VISIT DATE: 10/08/2024
NARRATIVE
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Continued from LIC809...

During today's visit, LPA learned that the facility is enrolled to start Technical Support Program from the Department to obtain guidance on medication management and other topics. The facility provided LPA with written documentation sent to C1's psychiatrist dated 9/16/24 at 10:28am from S2 requesting refill of Risperidone 1mg indicating that there were only 2 tabs left. On 9/18/24 at 5:33am S1 followed up with psychiatrist regarding the no refilled order indicating 0 tabs left. However, doctor was on vacation and did not respond. On 9/20/24 at 9:49am another staff followed up about the medication, but it wasn't refilled until 9/25/24 when another doctor sent the approval of the medication to the pharmacy. LPA obtained written documentation of meeting between S2 and human resources indicating that on 10/2/24 a corrective action was taken for staff to improve their performance within a period of 30 days. There is a review date scheduled for 11/7/24 to follow up with S2. LPA was provided with updated medication form regarding medication procedures indicating staff to send clients to emergency room care if their medication refill date is approaching within 48-24 hours and client do not have a refill on the premises.

Deficiencies are cited from the California Code of Regulations (CCRs), Title 22, Division 6, Chapter 1 and the Health and Safety Code. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with Program Director and appeal rights were given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC809 (FAS) - (06/04)
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