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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603814
Report Date: 06/14/2024
Date Signed: 06/14/2024 05:00:37 PM

Document Has Been Signed on 06/14/2024 05:00 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 30FACILITY NUMBER:
374603814
ADMINISTRATOR/
DIRECTOR:		ARCA, LUCIAFACILITY TYPE:
740
ADDRESS:14530 GARDEN RDTELEPHONE:
(858) 883-2680
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 6DATE:
06/14/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:26 PM
MET WITH: Administrator Anafe Rivera, Caregiver Maria Elena Bautista,TIME VISIT/
INSPECTION COMPLETED:
05:10 PM
NARRATIVE
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 Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced complaint visit. LPA introduced herself to Maria Elena Bautista and discussed the purpose of the visit.

During a tour of the facility LPA opened door to a resident (R1) bedroom. LPA smelled a strong odor of urine in the room and an unsanitary condition. Staff entered the room, confirmed the smell and agreed to clean up the unsanitary condition while LPA was onsite.

A deficiency was cited Per Title 22, Division 6, Chapter 8 of the California Code of Regulations (see LIC809-D). An exit interview was conducted with Anafe Rivera to whom a copy of this report and the Licensee appeal Rights (LIC9058) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2024
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 06/14/2024 05:00 PM - It Cannot Be Edited


Created By: Juliana Barfield On 06/14/2024 at 04:03 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 30
FACILITY NUMBER: 374603814

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/14/2024
Section Cited
CCR
87303(a)

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The facility shall be clean, safe and sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Staff immediately cleaned unsanitary condition and aired room to remove foul odor.

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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:Lizzette Tellez
LICENSING EVALUATOR NAME:Juliana Barfield
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2024


LIC809 (FAS) - (06/04)
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