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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603815
Report Date: 03/15/2024
Date Signed: 03/15/2024 01:46:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
02/27/2024 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20240227155411
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: 6DATE:
03/15/2024
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Assistant Administrator Von RiveraTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Licensee did not provide resident's authorized representative with resident's records
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in a complaint investigation on the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Assistant Administrator Von Rivera.

On February 27, 2024, Community Care Licensing (CCL) received a complaint alleging the responsible party did not receive a copy of admissions agreement with itemized items at signing on February 14, 2024. During the investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews. Interview with outside source revealed that R1 was moved into the facility late on February 14, 2024. Interview with Administrator confirmed that R1 was moved into the facility after hours and Administrator was unable to provide responsible party with admissions agreement. Interview with responsible party confirmed that they did not receive a copy of agreement at time of signing.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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 5
Control Number 08-AS-20240227155411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SOLARIS 36
FACILITY NUMBER: 374603815
VISIT DATE: 03/15/2024
NARRATIVE
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Based on interviews, and records reviewed, a preponderance of evidence exists to support the allegation. A technical violation is being issued due to no direct health, safety or personal rights risk to R1. An exit interview was conducted with Assistant Administrator Von Rivera, to whom a copy of this report,LIC9102 TV, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
02/27/2024 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20240227155411

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: 6DATE:
03/15/2024
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Assistant Administrator Von RiveraTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not issue a refund to resident's authorized representative
Staff did not ensure that resident’s hygiene needs were met
Staff did not dispense resident’s medication as prescribed
Staff did not seek medical attention
Staff did not ensure that the facility was free of pests

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings on the above complaint allegations. LPA identified herself and discussed the purpose of the visit with Assistant Administrator Von Rivera.

On February 27, 2024, Community Care Licensing (CCL) received a complaint with multiple allegations in regard to Resident 1 (R1), R1’s care, and the facility physical plant. During investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews. Based on Resident 1 (R1) Physician’s Report dated February 14,2024, R1 is diagnosed with a major neurocognitive disorder and encephalopathy, is bowel and bladder impaired, and is confused/disoriented. R1’s Appraisal signed February 14, 2024, revealed R1 requires assistance with toileting and eating, as well as medication management.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20240227155411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SOLARIS 36
FACILITY NUMBER: 374603815
VISIT DATE: 03/15/2024
NARRATIVE
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According to allegations R1’s responsible party was not issued a refund after only residing at the facility for five days. According to records collected, R1 moved into facility on February 14, 2024, and moved out on February 19, 2024. Interview with administrator revealed that a refund of $2,400 was issued. Interview with outside source revealed that resident’s responsible party verbally confirmed that the refund received was to be used for another facility. Interview with outside source confirmed that refund was forwarded to the facility R1 was moved into on February 21, 2024. Interview with responsible party established that responsible party agreed to have the funds forwarded to another facility.

It was also alleged that on February 16, 2024, R1 had bleeding from the rectum and facility staff did not clean R1 accordingly. Interview with staff revealed that the incident did occur, but R1 has a condition that causes rectal bleeding often. Interview with outside source revealed that R1 was observed to be clean and kempt on the date of the incident. Interview with other residents revealed that staff provided timely hygiene assistance. Records collected revealed R1 has diverticulitis of the colon.

It was also alleged that on February 17, 2024, R1 was not issued pain medication as prescribed. According to interview with outside source, staff were appropriately trained to provide R1 with sublingual medication for pain. Outside source also revealed that staff were continuously in contact with medical provider when requesting for guidance on medication administration. Interview with outside agency revealed that due to R1’s condition, some of R1’s medication would be spit up, but sublingual medication would provide effect even if spit out.

Additionally, it was alleged that staff did not seek medical assistance after having multiple bed bug bites and rectal bleeding on February 19, 2024. Interviews revealed that an outside agency was providing daily medical visits to R1. Interviews also revealed that bites could not be confirmed to be bed bugs and facility had not been exposed to bed bugs. Photographs collected could not confirm bites were a result of facility care. Records collected also confirmed that the outside source agency was providing medical care.

Lastly, it was alleged that facility did not treat for pest, resulting in R1 sustaining bug bites. According to staff, facility receives monthly pest treatment by a third-party contractor. During visit, LPA Strong did not observe any live pest in the facility. Based on records reviews, the facility has a continuous pest contract for monthly services.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20240227155411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SOLARIS 36
FACILITY NUMBER: 374603815
VISIT DATE: 03/15/2024
NARRATIVE
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5
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Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegation are unsubstantiated. An exit interview was conducted with Assistant Administrator Von Rivera, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5