374603816-7-24-2023-08-AS-DPOL-CU6RU8-20230728131931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603816
Report Date: 07/24/2023
Date Signed: 07/24/2023 07:31:05 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
01/18/2023 and conducted by Evaluator Esther Miller

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230118132306

FACILITY NAME:	SOLARIS 48		FACILITY NUMBER:	374603816
ADMINISTRATOR:	VON RIVERA		FACILITY TYPE:	740
ADDRESS:	14548 GARDEN RD		TELEPHONE:	(844) 320-1497
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	6	CENSUS: 6	DATE:	07/24/2023
		UNANNOUNCED	TIME BEGAN:	02:41 PM
MET WITH:	Roderick Arca, Assistant Manager		TIME COMPLETED:	03:08 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not seek timely medical attention for resident(s).
Facility staff did not ensure healthful environment for resident(s).

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 Roderick Arca, Assistant Manager, after identifying herself and explaining the reason for the visit.

On January 18, 2023, it was alleged that staff did not seek timely medical attention for resident and staff did not ensure there was a healthful environment for resident. The Department’s investigation consisted of review of facility records, outside source records, and interviews of facility staff and outside sources.

On January 9, 2023, someone close to Resident 1 (R1) called for paramedics after R1 had called them saying that they couldn’t breathe. Paramedics report show that they arrived at the facility around 7AM and were at the facility a total of fourteen (14) minutes before leaving. R1 reported to Paramedics that they did

[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: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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-20230118132306

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 48	FACILITY NUMBER: 374603816
	VISIT DATE: 07/24/2023

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

not have pain or a medical issue. Facility records indicated R1 requested that they be sent to the hospital after the paramedics left and facility staff complied. At the hospital, interviews revealed that R1 was diagnosed with a collapsed lung.

Facility records showed that R1 had spoken to Staff 1 (S1) around 5AM to complain about congestion due to allergies. S1 documented the interaction and gave R1 an allergy medication. S1 also reported that after the interaction, R1 fell asleep. S1 was not alarmed R1’s behavior at the time of interaction.

Based on the evidence obtained during the complaint investigation, the allegations that staff did not accord dignity to resident and staff did not provide resident with personal privacy are 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 Assistant Manager; a copy of this report and Licensee's Rights (LIC9058) were provided.

[Continued from LIC9099, Page 2 of 2]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2