486804139-1-5-2024-21-AS-CMAZ-D2F26V-20240213160744

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804139
Report Date: 01/05/2024
Date Signed: 01/05/2024 02:55:49 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
12/13/2023 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20231213151231

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:	DATE:	01/05/2024
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	Elizabeth Hall, Administrator		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Staff mismanaged resident medication

INVESTIGATION FINDINGS:

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On 1/5/2024, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Administrator, Elizabeth Hall. LPA toured the facility, interviewed staff, reviewed staff and client records, conducted medication review and made observations during the course of the investigation.

Complaint alleges staff mismanaged resident medication. Based on tour and observation, LPA observed staff conducting a medication pass for multiple clients. Two staff conduct medication pass with one staff verbally reciting medication order and second staff confirming prior to administration. Once medication is administered both staff were seen to properly sign off on the medication administration record. In addition, LPA observed staff input end date for exhausted medication and start date for new medication packets in the centrally stored medication record. LPA conducted a spot medication count for 5 clients (C2,C3,C4 & C5) and found all medication to be properly administered with counts in order. Upon review of records, LPA found that facility input start dates of medication directly on containers/bubble packs but not translated on multiple centrally stored medication records. Continued onto LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

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-20231213151231

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: 01/05/2024

NARRATIVE

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In addition, LPA conducted a file review of client (C1's) medication records and found that C1 had missed four doses of Lisinopril from 1/1/2024 - 1/4/2024 and currently missing 5 doses of Risperidone from 1/1/2024 - 1/5/2024. LPA and staff (S1) contacted client pharmacy and found that the facility does place orders for refills but are pending due to delay on physician's signature and order.

Although centrally store medication records require start date reconciling and client medication orders are delayed due outside entities, LPA was unable to find corroborating evidence indicating that staff mismanaged client medications therefore the allegation is found to be unsubstantiated. Technical Violation was issued requiring facility to update the Centrally Stored Medication Records start date in addition to a plan of action for medication refills.

Allegation, staff mismanaged resident medications is 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 during visit.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

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