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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603813
Report Date: 02/26/2025
Date Signed: 02/26/2025 11:36:07 AM

Document Has Been Signed on 02/26/2025 11:36 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SOLARIS 28FACILITY NUMBER:
374603813
ADMINISTRATOR/
DIRECTOR:		RIVERA, VONFACILITY TYPE:
740
ADDRESS:14528 GARDEN RDTELEPHONE:
(858) 883-5945
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: DATE:
02/26/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Administrator Jushua "Justin" Mendoza.
TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Case Management visit to respond to observations and interviews from a visit conducted on 2/08/2025. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Jushua "Justin" Mendoza.

During visits on 2/08/2024 and 2/26/2025, LPA toured the facility and observed resident in care. During the facility tour on 2/08/2025, LPA observed  resident's medications were stored in medication cups, cups were stored in a sectioned off plastic container with daily times for medication  and not in their original container.  LPA explained to Administrator Mendoza that they were to immediate  stop pre-pouring medications and dispense medication according to (community care licensing (CLL) guidelines.

(Continued on 809-C)
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SOLARIS 28
FACILITY NUMBER: 374603813
VISIT DATE: 02/26/2025
NARRATIVE
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(Continued form 809)

On 2/08/2025 LPA observed a pathway exiting from kitchen to common backyard blocking access to residents in care.  Pathway was blocked by  washer and dryer placed outside the common backyard exit/entrance door.

On 2/08/2025 LPA Observed uneven threshold in three doorways,(bathroom # 1 and Bedroom #4 and #5) bathroom #1 sink was not draining, cobwebs in all bathrooms and all bedrooms.  All resident doors had  fingerprints and splotches of dirt.  All Bathroom shelves have brown splotches and brown spots. The kitchen cabinets had  inside and outside debris/dirt and grease. The oven vent was greasy and had debris/dirt. The back yard shed was in disrepair and had a door hanging to the side. The  back yard fence in disrepair: missing pieces of fence and lattice is hanging off top of fence.


Based on the inspection, deficiencies were observed in the areas evaluated, and observed deficiencies are listed on the LIC 809-D pages.  An exit interview was conducted, and this report was discussed with Administrator Mendoza.  A copy of this report and Licensee/Appeal Rights (01/2016) were provided to the Administrator at the conclusion of the visit, and his signature on this form acknowledges receipt of the rights and a copy of this report.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/26/2025 11:36 AM - It Cannot Be Edited


Created By: Amy Rodgers On 02/25/2025 at 07:43 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
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SOLARIS 28
FACILITY NUMBER: 374603813

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/26/2025
Section Cited
CCR
87465(h)(5)

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87465 Incidental Medical and Dental Care (h) The following....medications which are centrally stored: (5) Each resident's medication...stored in its originally received container. No medications shall be transferred between containers.
This requirement is not met as evidenced by:
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LPA spoke with Administered on 2/7/2025 regarding the pre-pour of medications.
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Based on LPA observation, the licensee did not comply with the section cited above in that 4 of 5 [R1,R2,R3, R4, R5] resident's medications are stored in a medication cups, which poses a potential health risk to residents in care.

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LPA instructed Administrator to cease immediately the pre-pouring of medications and to instruct caregivers to give resident medications directly from the pill bottle and not from the pillbox and to not pre-pour medication.
Type B
03/12/2025
Section Cited
CCR87303(a)

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The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance... for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:

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 LPA spoke as well as toured the property with Administrator on 2/7/2025. Administrator was instructed by LPA to clean and repair the inside of the facility as well as the repair of backyard fencing and outside storage shed. LPA observed a clean and in good repair facility on 3/12/2025.
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Based on observations, the licensee did not ensure the facility was in good repair for 5 out of 5 [R1-R5] residents, due to uneven threshold in two doorways, bathroom sink not draining, cobwebs in bathrooms and bedrooms, inside and outside debris/dirt and greasy cabinets, greasy debris/dirt stove vent, back yard shed in disrepair, back yard fence in disrepair which poses a potential health and safety risk to persons 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:Denise Powell
LICENSING EVALUATOR NAME:Amy Rodgers
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 02/26/2025 11:36 AM - It Cannot Be Edited


Created By: Amy Rodgers On 02/25/2025 at 07:57 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
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SOLARIS 28
FACILITY NUMBER: 374603813

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/26/2025
Section Cited
CCR
87465(d)(6)

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(d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.

This was evidenced by:
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LPA spoke as well as toured the property with Administrator on 2/7/2025. Administrator was instructed by LPA to clean area and remove the washer and dryer outside the common backyard exit/entrance door. LPA observed the exit/entrance clear from obstructions on 2/26/2025.
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Based on observation ,the licensee did not ensure the facility passageways were kept free from obstruction for X of X [R1-R5] residents, due to the washer and dryer placed outside the common backyard exit/entrance door, the licensee did not comply with the section cited above in which posed a potential health and safety risk to xx persons 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:Denise Powell
LICENSING EVALUATOR NAME:Amy Rodgers
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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