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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603813
Report Date: 07/13/2022
Date Signed: 07/13/2022 05:36:08 PM

Document Has Been Signed on 07/13/2022 05:36 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SOLARIS 28FACILITY NUMBER:
374603813
ADMINISTRATOR:RIVERA, VONFACILITY TYPE:
740
ADDRESS:14528 GARDEN RDTELEPHONE:
(844) 320-1497
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 6DATE:
07/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:Jushua Mendoza, CaregiverTIME COMPLETED:
12:29 PM
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Licensing Program Analyst (LPA) Esther Miller conducted a case management visit to give a technical violation identified during a separate visit for a separate facility. The facility is in close proximity to other facilities on a large cul-de-sac. LPA knocked on the front door and Staff 1 (S1) opened the door without a mask. LPA inquired what facility she was at and where she could find the correct facility for the visit that was intended. After S1 directed LPA to the correct facility, LPA asked if S1 was a caregiver. S1 denied that they were a caregiver. LPA requested to speak to a caregiver. S1 walked away and returned without a mask to direct LPA to the facility she had inquired of. Again, LPA asked if S1 was a caregiver and S1 denied that they were a caregiver. LPA requested a caregiver. S1 walked away and retuned with a mask and stated that they were a caregiver and they had lied because they were scared.

A technical violation was cited Per Title 22, Division 6, Chapter 8 of the California Code of Regulations (see LIC9102). An exit interview was conducted with caregiver to whom a copy of this report and the Licensee appeal Rights (LIC9058) were provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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