374603815-8-31-2022-08-AS-LTEZ-CHU2V7-20220831174327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603815
Report Date: 06/30/2022
Date Signed: 08/31/2022 08:54:23 AM

Unsubstantiated

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
03/04/2020 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20200304165143

FACILITY NAME:	SOLARIS 36		FACILITY NUMBER:	374603815
ADMINISTRATOR:	ARCA, LUCIA		FACILITY TYPE:	740
ADDRESS:	14536 GARDEN RD		TELEPHONE:	(844) 320-1497
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	6	CENSUS: 5	DATE:	06/30/2022
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Anafe Rivera, Site Manager		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident sustained unexplained injuries while in care.

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 Anafe Rivera, Site Manager, to whom LPA disclosed the reason for the visit.

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

It was reported to Community Care Licensing that Resident 1 (R1) sustained bruising to his/her hand while in the care of facility staff. A review of records maintained by the facility reflected that on 2/13/2020, it was observed that R1 had bruising on his/her hand. On 2/14/2020, it was noted that between the 4th and 5th knuckle area of R1’s left hand appeared swollen and bruised. Records reviewed and interviews conducted during the investigation did not yield any evidence that bruising on R1’s hand resulted from any actions or
**This is an amended version of the original report created on 06/30/2022.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200304165143

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 36	FACILITY NUMBER: 374603815
	VISIT DATE: 06/30/2022

NARRATIVE

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inactions of facility staff. Records reviewed and interviews revealed that R1 was resistive to care and often grabbed on to people and things and would not let go. Additionally, during the investigation, R1 was observed by Community Care Licensing staff engaging in aggressive behaviors that could have resulted in self-harm. Considering the foregoing, it was indeterminable what occurred that resulted in the bruising on R1’s hand.

Based upon a lack of evidence to conclude that R1 sustained injuries as a result of staff’s actions or inactions, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, evidence was not obtained to prove that the alleged violation occurred.

An exit interview was conducted with Anafe Rivera, and copies of this report and Licensee/Appeal Rights (LIC 9058) were provided to the Site Manager at the conclusion of the visit. Anafe Rivera’s signature on this report acknowledges receipt of copies of the rights and report.

**This is an amended version of the original report created on 06/30/2022**.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022

LIC9099 (FAS) - (06/04)

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