306006677-4-3-2026-22-AS-EKIM-DSSVRP-20260403164017

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006677
Report Date: 04/03/2026
Date Signed: 04/03/2026 04:40:33 PM

Document Has Been Signed on 04/03/2026 04:40 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	SOLAIRE HOME		FACILITY NUMBER:	306006677
ADMINISTRATOR/ DIRECTOR:	TUASON, LIEZL		FACILITY TYPE:	734
ADDRESS:	17777 BUENA VISTA		TELEPHONE:	(909) 841-6315
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY: 5		CENSUS: 3	DATE:	04/03/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:30 PM
MET WITH:	Administrator- Liezl Tuason		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On April 3, 2026, at 2:30 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced Case Management Visit to follow-up on a death report received from the facility. LPA Kim met with Administrator (ADMIN) Liezl Tuason. During today’s visit, LPA conducted a health and safety check, and there were no imminent health/safety concerns observed. Facility is maintained at a comfortable temperature for the clients care. LPA obtained Staff Roster, Client Roster, and C1’s records which includes the Physician’s Report, Facesheet, Appraisal and Needs/Service Plan, Medication Administration Record, Integrated Progress Notes, Incident Reports, Hospitalization records, and other pertinent documents. LPA interviewed two staff and one witness. Based on record review, the Incident report received by the Orange County Regional Office on April 3, 2026, R1 was sent to the hospital on April 2,2026, around 6:10 AM, Client #1 (C1) experienced a sudden change in condition. C1 became cyanotic, with a heart rate of 56 and oxygen saturation in the low 80s while on the ventilator. Staff immediately initiated rescue breathing via tracheostomy using an Ambu bag and called 911. Paramedics arrived and departed the facility with C1 at 6:22 AM. When C1 arrived to the emergency, C1 went into cardiac arrest. Prior to C1’s death, C1 had been undergoing treatment for a urinary tract infection since March 27, 2026. C1 experienced intermittent fever and tachycardia, which were managed by their primary care physician. C1’s condition appeared more stable throughout April 1, 2026. Evaluation Report Continues on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Edward Kim
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SOLAIRE HOME	FACILITY NUMBER: 306006677
	VISIT DATE: 04/03/2026

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Based on interviews conducted, one witness and two staff denied this to be a questionable death. W1 stated C1 passed away due to cardiac arrest. There is no foul play suspected from the facility. S1 and S2 stated facility staff followed all emergency protocols and handled everything in a timely manner. A copy of the Coroner's Report and Death Certificate were also requested and the facility stated they would provide copies at a later date when they receive it.

An exit interview was conducted, and a copy of this report was provided to the Administrator Liezl Tuason.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Edward Kim
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC809 (FAS) - (06/04)

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