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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603815
Report Date: 10/30/2023
Date Signed: 10/30/2023 05:15:08 PM

Document Has Been Signed on 10/30/2023 05:15 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 36FACILITY NUMBER:
374603815
ADMINISTRATOR:ARCA, LUCIAFACILITY TYPE:
740
ADDRESS:14536 GARDEN RDTELEPHONE:
(858) 842-4246
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 5DATE:
10/30/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:16 PM
MET WITH:TIME COMPLETED:
05:32 PM
NARRATIVE
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Licensing Program Analyst (LPA) Becky Kennedy conducted an unannounced case management visit to cite violations that were identified during a complaint investigation. LPA was met by Veyl Vidal, Caregiver and was granted entry into the facility. LPM met with Anafe Rivera, Site Manager to discuss the purpose of the visit.

Interviews revealed that from late February 2020 through part of May 2020, the facility’s administrator was out of the country, and thus not present to observe residents or supervise staff. S4 was left in charge of the facility. However, according to interviews, and corroborated by CCLD’s records, S4 did not have an RCFE Administrator Certificate, and was thus unqualified to provide full-time, ongoing leadership at the facility.

This deficiency is being cited per California code of Regulations, Title 22, on the attached LIC 809D. An exit interview was conducted with Anafe Rivera, Site Manager and a copy of this report, LIC 421IM, Confidential Names form (LIC 811) and Licensee/Appeal Rights (LIC 9058 01/16), were provided to them at the conclusion of the visit.

SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2023
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 10/30/2023 05:15 PM - It Cannot Be Edited


Created By: Becky Kennedy On 10/26/2023 at 02:46 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 36
FACILITY NUMBER: 374603815

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/13/2023
Section Cited
CCR
87405(a)

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All facilities shall have a qualified and currently certified administrator…. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section…
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Facility will develop a policy for ensuring that a certified administrator will be presnet at the facility during periods of extended absence from the facility by the regular administrator. This policy will be sent to to licensing by the POC date.
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 This requirement was not met as evidenced by the administrator being absent and leaving the facility without a qualified substitute posing a potential risk to six of six 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.
SUPERVISOR'S NAME:Icela Estrada
LICENSING EVALUATOR NAME:Becky Kennedy
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023


LIC809 (FAS) - (06/04)
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