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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803688
Report Date: 07/30/2021
Date Signed: 07/30/2021 02:17:45 PM

Document Has Been Signed on 07/30/2021 02:17 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:SOLANO QUALITY HOME CAREFACILITY NUMBER:
486803688
ADMINISTRATOR:PRAKASH, SNEH LATAFACILITY TYPE:
740
ADDRESS:266 DE SOTO DRIVETELEPHONE:
(707) 386-3600
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 6CENSUS: 3DATE:
07/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Dinesh Prakash, LicenseeTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct a Required - 1 Year inspection and met with Dinesh Prakash, Licensee. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly.
LPA discussed with Licensee implementing a screening station at front entrance to include COVID-19 questionnaires for anyone entering the facility (staff and all visitors). Licensee stated staff screen visitors verbally for COVID-19 symptoms; LPA discussed documenting COVID-19 questionnaires and screen all visitors/staff. LPA observed a thermometer and a sign-in sheet for staff & visitors.
Licensee wore a face mask during this visit. The facility has submitted a COVID-19 Mitigation Plan Report on Epidemic Outbreaks specific to COVID-19 which was reviewed by the California Department of Social Services.
Resident's temperatures are taken once a day and LPA advised to document daily temperatures taken. LPA conducted a walk-through of the facility with Licensee and observed COVID-19 precaution postings. Licensee stated staff clean and disinfect the facility everyday. LPA discussed with Licensee to implement a cleaning schedule to ensure high-touched surface areas are disinfected after use. The facility has a designated visitation area and provides phone calls for family to stay in contact with residents.
LPA observed 3 residents in care. Facility staff have completed training on PPE use, isolation policies, and infection prevention; LPA advised to document the staff training (duration, date, topic, and staff who were present). N-95 respirator Fit testing (Cal/OSHA requirement) is in process. LPA observed a supply of PPE including gloves, face shields, N-95 respirators, surgical masks and disposable gowns.

Exit interview conducted with Licensee, whose signature on this document confirms receipt.
No deficiencies cited during this inspection
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2021
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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