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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603813
Report Date: 03/14/2025
Date Signed: 03/14/2025 02:09:33 PM

Document Has Been Signed on 03/14/2025 02:09 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
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: 6DATE:
03/14/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:01 PM
MET WITH:Justin Mendoza, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Amy Rodgers conducted an Case Management visit to respond to observations and interviews from a visit conducted on 3/14/2025. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Jushua "Justin" Mendoza.

During today’s visit, LPA observed Staff #1 open a non-locking drawer in the facility’s kitchen, which contained the keys to the locked medication cabinet and proceed to unlock mediation cabinet.   LPA also interviewed the administrator and he explained the open non-locking facility kitchen drawer is where the keys are normally stored. After the observation was made LPA was able to observe Staff#1 place keys in their pocket and LPA advised Staff#1, as well as the administrator, keys to the centrally stored medication cabinets should never be made accessible to clients or guests in the home.

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: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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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Document Has Been Signed on 03/14/2025 02:09 PM - It Cannot Be Edited


Created By: Amy Rodgers On 03/14/2025 at 01:39 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: 03/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/14/2025
Section Cited
CCR
87465(h)(2)

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87465 Incidental Medical and Dental Care: “(h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.” This requirement was not met, as evidenced by:
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During today's visit, LPA observed employee remove keys from kitchen drawer and keep on their person. This resolved the immediate risk. Licensee agreed to retrain all current staff on
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Based on LPA observation, Licensee did not ensure that centrally stored medicines were kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This posed an immediate health and safety risk to 6 of 6 residents (R1 through R6) in care.
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expectations regarding safe storage of centrally stored medications, and to E-mail the training sign-in sheet to LPA by 04/14/2025.

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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: 03/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2025


LIC809 (FAS) - (06/04)
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