374603815-8-31-2022-08-AS-LTEZ-CHU2ZR-20220831175046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603815
Report Date: 08/30/2022
Date Signed: 08/31/2022 12:01:22 PM

Substantiated

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
04/09/2020 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20200409163550

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:	08/30/2022
		UNANNOUNCED	TIME BEGAN:	01:51 PM
MET WITH:	Anafe Rivera, Site Manager		TIME COMPLETED:	03:14 PM

ALLEGATION(S):

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Staff hit resident.

Staff yelled at resident.

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 she disclosed the reason for the visit.

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

It was alleged that facility staff yelled at Resident 1 (R1) and hit the same resident. It was reported to CCL, via an Unusual Incident/Injury Report that was completed by facility staff, that on the evening of 4/8/2020, R1, who typically received assistance with toileting, went to the bathroom alone. While in the bathroom, R1 had a fall and was not able to get up on his/her own. R1 called for help, and Staff 1 (S1) went to the bathroom and found R1 on the bathroom floor. S1 was not able to get R1 up from the floor alone, so S1 called for help. Staff 2 (S2) came over from a neighboring facility to assist.

Substantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

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-20200409163550

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: 08/30/2022

NARRATIVE

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Evidence obtained during the course of the investigation revealed that when S2 arrived, R1 was on the floor in feces. Evidence further indicated that S2 was alone in the bathroom with R1 while S2 was picking up and cleaning R1 after the fall. The investigation yielded that during the time in which S2 was in the bathroom with R1, S2 yelled at R1 and hit R1. Following the exchange, when S2 and R1 emerged from the bathroom, R1 was in his/her wheelchair, and R1 was returned to his/her bedroom.

Based upon the investigation yielding corroborating evidence, the allegations are substantiated. This finding means that the preponderance of the evidence standard has been met and the allegations are valid. Deficiencies are cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 9099-D.

An exit interview was conducted with Anafe Rivera, Site Manager, 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.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20200409163550

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/30/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/27/2022 Section Cited CCR 87413(a)(2)	1 2 3 4 5 6 7	Personnel – Operations. In each facility: (2) Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Site manager offered to ensure that all staff who provide services at the facility will receive personal rights, fall prevention, and elder abuse/mandated reporter training from an approved outside vendor. Proof of training will be provided to Community Care Licensing by the POC due date of 9/27/2022.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not ensure that care was provided without physical abuse to 1 of 5 residents in care, which posed a potential personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 09/27/2022 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Site manager offered to ensure that all staff who provide services at the facility will receive personal rights, fall prevention, and elder abuse/mandated reporter training from an approved outside vendor. Proof of training will be provided to Community Care Licensing by the POC due date of 9/27/2022.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not ensure that 1 of 5 residents was accorded dignity in their personal relationship with staff. This posed a potential personal rights risk to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC9099 (FAS) - (06/04)

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