<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603815
Report Date: 07/28/2022
Date Signed: 07/29/2022 01:19:50 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
03/03/2020 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20200303151331
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: 6DATE:
07/28/2022
UNANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Jushua Mendoza, StaffTIME COMPLETED:
04:38 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is not meeting resident's incontinent care needs.

Facility staff are not allowing residents to exercise choices concerning their daily lives in the facility.

Licensee interfered with resident’s right to select their own hospice agency.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Jushua Mendoza, Staff, to whom LPA disclosed the reason for the visit.

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

It was reported to Community Care Licensing that facility staff were not meeting the incontinent care needs of Resident 2 (R2). It was alleged that facility staff would leave R2 wet to the point of a puddle of urine accumulating and the presence of an overpowering smell of urine in the home. It was also reported that staff were putting double and triple briefs on the resident. Interviews conducted during the investigation revealed that R2 wore briefs during his/her entire stay in the facility. Based upon interviews conducted, R2 did not like to be changed, so facility staff would allow R2 to sit in adult briefs for extended periods of time without
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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 4
Control Number 08-AS-20200303151331
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: 07/28/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
changing the briefs. Interviews also revealed that while R2 resided in the facility, to address incontinent needs, staff would put multiple incontinence products on the resident at the same time.

The second allegation is that facility staff were not allowing residents to exercise personal choices by forcing residents to shower, even if residents chose not to. Interviews conducted revealed that, oftentimes, R2 would not want to be showered. Although the resident would regularly be given bed baths and would adamantly express his/her desire to not be showered, facility staff would not honor the resident’s desires and, at times, would insist on the resident having showers during visits conducted by hospice care staff.

It was also alleged that the licensee interfered with R2’s right to select his/her own hospice agency. It was determined during the investigation that R2 received services from a hospice agency, from which R2 graduated from the services provided by the agency. Following R2’s discharge from the first agency, facility staff took steps to enroll R2 into services with another hospice agency. Within a month, R2’s responsible party was notified that a hospice agency had been selected, and it was requested that the responsible party attend a meeting, during which R2’s responsible party signed to have R2 admitted into the hospice agency that had been selected by facility staff. It was determined during the investigation that R2’s responsible party had no input or participation in selecting the second hospice agency into which R2 was admitted.

Based upon interviews conducted and records reviewed, the above 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 Jushua Mendoza, Staff, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to the staff at the conclusion of the visit. Jushua Mendoza's signature on this form acknowledges receipt of copies of the rights and report.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20200303151331
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: 07/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2022
Section Cited
CCR
87625(b)(3)
1
2
3
4
5
6
7
Managed Incontinence. (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:
(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.
1
2
3
4
5
6
7
Facility staff offered to schedule training on meeting and addressing resident needs, particularly incontinence care. The training will be conducted by an outside vendor and provided to all managers, administrators, and staff. Proof of training topics and attendance will be provided to Community
8
9
10
11
12
13
14
This requirement was not met as evidenced by:
Based on interviews, the licensee did not ensure that briefs were regularly changed to keep 1 of 6 residents in care clean and dry. This posed a potential health risk to residents in care.
8
9
10
11
12
13
14
Care Licensing by the POC due date of 8/18/2022.
Type B
08/18/2022
Section Cited
CCR
87468.2(a)(6)
1
2
3
4
5
6
7
Additional Personal Rights of Residents in Privately Operated Facilities. (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (6) To make
1
2
3
4
5
6
7
Facility staff offered to schedule personal rights training. The training will be conducted by an outside vendor and provided to all managers, administrators, and staff. Proof of training and attendance will be provided to Community Care Licensing by the POC due date of 8/18/2022.
8
9
10
11
12
13
14
choices concerning their daily lives in the facility. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not honor the shower choices of 1 of 6 residents in care. This posed a potential personal rights risk to residents 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.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20200303151331
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: 07/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2022
Section Cited
CCR
87468.2(a)(18)
1
2
3
4
5
6
7
Additional Personal Rights of Residents in Privately Operated Facilities. (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (18) To select their own . . .
1
2
3
4
5
6
7
Facility staff offered to schedule personal rights training. The training will be conducted by an outside vendor and provided to all managers, administrators, and staff. Proof of training and attendance will be provided to Community Care Licensing by the POC due date of 8/18/2022.
8
9
10
11
12
13
14
hospice agency. . .according to these personal rights. This requirement was not met as evidenced by: Based on interviews, the licensee did not allow 1 of 6 residents in care to select their own hospice agency. This posed a potential personal rights risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4