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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603815
Report Date: 02/26/2025
Date Signed: 02/26/2025 11:17:44 AM

Document Has Been Signed on 02/26/2025 11:17 AM - 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/
DIRECTOR:		ARCA, LUCIAFACILITY TYPE:
740
ADDRESS:14536 GARDEN RDTELEPHONE:
(858) 842-4246
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 5DATE:
02/26/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Justin Mendoza, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Case Management Visit to cite deficiencies which were identified during a separate visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Justin Mendoza, Administrator.

On 02/07/2025 and on today's date, LPA Holmes reviewed records and conducted a tour of the facility and observed residents in care.

According to records reviewed:

~There weren't any prescriptions for a bed rail on one of the residents beds.

~There weren't any prescriptions for over the counter medications.

LPA observations also revealed:

~The physical plant was unclean by having several large spider webs in the bathroom

~ Facility also had a broken toilet seat that

was not able to be used.

~Several rooms were missing chairs

~The hot water was over 120 degrees at the time of the visit.

Based on records reviewed, inspection, interviews and LPA observations deficiencies are being cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D pages)

An exit interview was conducted with Justin Mendoza, Administrator. A copy of this report, the LIC 809-D page and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
Document Has Been Signed on 02/26/2025 11:17 AM - It Cannot Be Edited


Created By: Tiffany Holmes On 02/26/2025 at 09:54 AM
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: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/27/2025
Section Cited
CCR
87303(2)

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Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by:
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Licensee turned down water temperature while LPA was at the facility. Licensee will check and montior daily to make sure the water is not too hot. Licensee will send a photo of water in normal range by POC due date of 02/27/2025
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Based on LPA observation, the licensee did not comply with the section cited above for hot water over 120 for 5 out of 5 residents (5residents), which poses an immediate health risk to residents in care
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Type B
03/12/2025
Section Cited
CCR87303(a)

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The facility shall be clean, safe, 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. This requirement is not met as evidenced by:
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Licensee will keep all bathrooms clean and monitor for spider webs. Bathroom is under construction due to a leak at this time and will be completed by 03/12/2025. POC is due by 03/12/2025
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Based on LPA observation, the licensee did not comply with the section cited above, there were several large spider webs at the ceiling in the bathroom and the bathroom is under construction that is used by 5 out of 5 residents (5 residents), which poses a potential health 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.
SUPERVISOR'S NAME:Denise Powell
LICENSING EVALUATOR NAME:Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 02/26/2025 11:17 AM - It Cannot Be Edited


Created By: Tiffany Holmes On 02/26/2025 at 09:54 AM
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: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2025
Section Cited
CCR
87303(6)

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Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs.This requirement is not met as evidenced by:
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Licensee fixed the toilet seat by putting a new toilet seat on.

Corrected during the visit.
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Based on LPA observation, the licensee did not comply with the section cited above, there was a broken toilet seat that could not be used by 5 out of 5 residents (5 residents), which poses a potential health risk to residents in care
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Type B
02/27/2025
Section Cited
CCR87307(2)(B)

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Resident bedrooms shall be provided which meet, at a minimum, the following requirements:Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers.This requirement is not met as evidenced by:
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Licensee put chairs in all of the rooms during the visit.

Corrected the during the visit
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Based on LPA observation, the licensee did not comply with the section cited above in 4 out of 4 resident rooms were missing chairs (4 residents), which poses a potential health 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.
SUPERVISOR'S NAME:Denise Powell
LICENSING EVALUATOR NAME:Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/26/2025 11:17 AM - It Cannot Be Edited


Created By: Tiffany Holmes On 02/26/2025 at 09:54 AM
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: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2025
Section Cited
CCR
87608(3)

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A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.This requirement is not met as evidenced by:

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Licensee immedaitely removed the bed rail.

Corrected during the visit
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Based on LPA observation, the licensee did not comply with the section cited above in 1 out of 5 residents (1 residents) did not have a prescription for a bedrail, which poses a potential health risk to residents in care
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Type B
03/06/2025
Section Cited
CCR87465c()(1)

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(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met:

(1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication when the physician should be contacted for a medication reevaluation.
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Licensee contacted Residents son to contact the doctor to attain a prescription for the over the counter mediations. POC due by 03/06/2025. Licensee will subnit to LPA by email a copy of the prescription
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Based on LPA observation, the licensee did not comply with the section cited above in 1 out of 5 residents (1 residents) by having a prescription for over the counter medications , which poses a potential health 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.
SUPERVISOR'S NAME:Denise Powell
LICENSING EVALUATOR NAME:Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
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