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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603815
Report Date: 07/13/2022
Date Signed: 07/13/2022 05:47:49 PM

Document Has Been Signed on 07/13/2022 05:47 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SOLARIS 36FACILITY NUMBER:
374603815
ADMINISTRATOR:ARCA, LUCIAFACILITY TYPE:
740
ADDRESS:14536 GARDEN RDTELEPHONE:
(844) 320-1497
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 4DATE:
07/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:18 AM
MET WITH:Jushua "Justin" Mendoza, CaregiverTIME COMPLETED:
11:48 AM
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Licensing Program Analyst (LPA) Esther Miller conducted a case management visit to give a Technical Violation identified during a separate visit. LPA knocked on the front door and Staff 1 (S1) opened the door without a mask. LPA identifying herself and disclosed the purpose of the visit. LPA then asked if S1 had a mask. LPA observed that S1 quickly put on a mask.

During the visit, two visitors entered the facility without a mask and entered a resident room. LPA observed that visitors did not sign a visitor log, S1 did not screen them for COVID, and did not ask that they were a mask. Jushua "Justin" Mendoza, caregiver, was made aware of the visitors by the LPA. Caregiver requested the visitors to sign in and wear a mask.

A technical violation was cited Per Title 22, Division 6, Chapter 8 of the California Code of Regulations (see LIC9102). An exit interview was conducted with caregiver to whom a copy of this report and the Licensee appeal Rights (LIC9058) were provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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