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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603814
Report Date: 07/28/2022
Date Signed: 07/29/2022 01:24:26 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/03/2020 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20200303150411
FACILITY NAME:SOLARIS 30FACILITY NUMBER:
374603814
ADMINISTRATOR:ARCA, LUCIAFACILITY TYPE:
740
ADDRESS:14530 GARDEN RDTELEPHONE:
(858) 883-2680
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 6DATE:
07/28/2022
UNANNOUNCEDTIME BEGAN:
04:43 PM
MET WITH:Jushua Mendoza, StaffTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Licensee interfered with residents’ right to select their own hospice agency.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Jushua Mendoza, Staff, to whom LPA disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above listed complaint allegation. The investigation consisted of interviews of staff and outside sources.

It was alleged that the licensee interfered with residents’ right to select their own hospice agency. Based upon interviews conducted during the investigation, it was determined that Resident 1 (R1) was admitted into hospice services upon moving into the facility. During the course of his/her stay, R1 received hospice services from two hospice agencies at different times. It was determined that Resident 2 (R2) also received services from two different hospice agencies during his/her time in the facility. Interviews conducted yielded that selections of hospice agencies for both residents were conducted by facility staff. The investigation
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 08-AS-20200303150411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SOLARIS 30
FACILITY NUMBER: 374603814
VISIT DATE: 07/28/2022
NARRATIVE
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revealed that facility staff selected the agencies and made all necessary arrangements to enroll the residents in hospice care. Information obtained reflects that each resident’s responsible party was notified of which agency the resident would be enrolled into and were provided paperwork for completion to effectuate the hospice admissions after facility staff made the selections. Based upon information obtained, R1, R2 and/or their responsible parties were either not made aware of or provided options or choices and were not a part of the selection process.

Based upon interviews conducted, the above allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. Deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 9099-D.

An exit interview was conducted with Jushua Mendoza, Staff, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to the staff at the conclusion of the visit. Jushua Mendoza’s signature on this form acknowledges receipt of copies of the rights and report.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20200303150411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SOLARIS 30
FACILITY NUMBER: 374603814
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2022
Section Cited
CCR
87468.2(a)(18)
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Additional Personal Rights of Residents in Privately Operated Facilities. (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (18) To select their own . . .
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Facility staff offered to schedule personal rights training. The training will be conducted by an outside vendor and provided to all managers, administrators, and staff. Proof of training and attendance will be provided to Community Care Licensing by the POC due date of 8/18/2022.
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hospice agency. . .according to these personal rights. This requirement was not met as evidenced by: Based on interviews, the licensee did not allow 2 of 6 residents in care to select their own hospice agency. This posed a potential personal rights risk to residents 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.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/03/2020 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20200303150411

FACILITY NAME:SOLARIS 30FACILITY NUMBER:
374603814
ADMINISTRATOR:ARCA, LUCIAFACILITY TYPE:
740
ADDRESS:14530 GARDEN RDTELEPHONE:
(858) 883-2680
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 6DATE:
07/28/2022
UNANNOUNCEDTIME BEGAN:
04:43 PM
MET WITH:Jushua Mendoza, StaffTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility staff is threatening resident with punitive action.

Unskilled staff are performing glucose testing on resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Jushua Mendoza, Staff, to whom LPA disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above listed complaint allegations. The investigation consisted of a review of facility records and interviews of staff and outside sources.

It was reported to Community Care Licensing that facility staff were threatening to withhold food, not allow resident to watch television, or to prevent family visits if the resident did not shower. Interviews conducted during the course of the investigation did not reveal information to corroborate the allegation or to conclude that the allegation occurred.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20200303150411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SOLARIS 30
FACILITY NUMBER: 374603814
VISIT DATE: 07/28/2022
NARRATIVE
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The second allegation is that facility staff who are not appropriately skilled performed glucose testing on Resident 2 (R2). During the course of the investigation, it was confirmed that R2 was a resident who had a diagnosis of diabetes. A review of records reflected that R2 was prescribed diabetes medication in a pill form, but the investigation did not yield evidence to conclude that facility staff, particularly staff who were not appropriately skilled, were testing R2’s glucose levels.

Based upon a lack of evidence to corroborate the above listed allegations, the allegations are unsubstantiated. This finding means that although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with Jushua Mendoza, Staff, and copies of this report and Licensee/Appeal Rights (LIC 9058) were provided to the staff at the conclusion of the visit. Jushua Mendoza’s signature on this report acknowledges receipt of copies of the rights and report.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5