374603815-4-27-2023-08-AS-DPOL-CSBV93-20230530161341

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603815
Report Date: 04/27/2023
Date Signed: 04/27/2023 04:49:47 PM

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
07/05/2022 and conducted by Evaluator Esther Miller

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220705170058

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: 6	DATE:	04/27/2023
		UNANNOUNCED	TIME BEGAN:	11:32 AM
MET WITH:	Jushua "Justin" Mendoza, Caregiver		TIME COMPLETED:	01:04 PM

ALLEGATION(S):

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Staff neglected resident resulting in hospitalization.
Staff neglected resident resulting in pressure injuries.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced complaint investigation visit to the facility in order to deliver findings on the above allegations. LPA was granted entry to the facility by Jushua "Justin" Mendoza, Caregiver, after identifying herself and explaining the reason for the visit.

On July 5, 2022, it was alleged that staff neglected resident resulting in hospitalization, specifically for malnutrition, and that staff neglected resident resulting in pressure injuries. The Department’s investigation consisted of review of facility records, outside source records, and interviews of facility staff and outside sources.

Facility records indicate that Resident 1 (R1) was admitted into the facility on February 13, 2022. Interviews and outside sources indicated that R1 was able to verbalize their needs and was bedbound.

[Continued on LIC9099-C, Page 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 08-AS-20220705170058

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: 04/27/2023

NARRATIVE

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[Continued from LIC9099, Page 2 of 2]

Facility records and outside source interviews indicated that R1 was not eating all their food and was supplementing their diet with nutritional shakes. Outside source records also indicated that R1 has always had a poor appetite. While there was conflicting information on how much R1 was in taking, outside source documents indicated that R1 was sent to the hospital due to generalized weakness and not eating on June 30, 2022. Outside source documents indicated that hospital sent R1 back to the facility on July 1, 2022. Hospital discovered that R1’s blood was positive for an infection and R1 returned to the hospital on July 2, 2022. Outside source records indicated that R1 had a decreased appetite and had a diagnosis of retropharyngeal abscess, which made it difficult to swallow.

It was further alleged that staff neglected resident resulting in pressure injuries. R1 was admitted into hospice on February 15, 2022. Staff interviews and outside source documents indicated that R1 was scratching an area where a pressure injury later formed, which was first documented on April 13, 2022. It was not determined to be a pressure injury but was under observation by the hospice nurse. Outside source documents and interviews indicated Staff 1 (S1) told hospice nurse that R1 did not consent to being repositioned. Hospice nurse did not make a change in care plan. Outside source interviews and records indicated that hospice nurse first documented R1’s pressure injuries to be Stage 2 on June 28, 2022.

Based on the evidence obtained during the complaint investigation, the allegations that staff neglected resident resulting in hospitalization and that staff neglected resident resulting in pressure injuries is found to be UNSUBSTANTIATED, meaning that although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with caregiver; a copy of this report and Licensee's Rights (LIC9058) were provided.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC9099 (FAS) - (06/04)

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