374603816-1-25-2024-08-AS-DPOL-CZZW3R-20240131155619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603816
Report Date: 01/25/2024
Date Signed: 01/25/2024 04:22:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
01/17/2024 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20240117151816

FACILITY NAME:	SOLARIS 48		FACILITY NUMBER:	374603816
ADMINISTRATOR:	VON RIVERA		FACILITY TYPE:	740
ADDRESS:	14548 GARDEN RD		TELEPHONE:	(858) 842-4246
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	6	CENSUS: 6	DATE:	01/25/2024
		UNANNOUNCED	TIME BEGAN:	01:16 PM
MET WITH:	Jushia Mendoza, Caregiver		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not assist resident with incontience care
Staff did not administer medications as prescribed
Staff did not treat resident with dignity
Staff did not report resident's change in condition

INVESTIGATION FINDINGS:

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On 01/25/2024, at about 01:16 PM, Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced visit to open a complaint investigation. LPA identified himself and discussed the allegations mentioned above with Caregiver/House Manager, Jushia Mendoza. Anafe Rivera, Licensee later joined LPA during the visit. LPA delivered investigative findings to Mr. Mendoza at the conclusion of the visit.

On 01/17/2024, the Department received a complaint, alleging staff did not assist a resident with incontinence care, did not administer medications as prescribed, did not treat resident with dignity, and did not report a change of condition of resident. The Department’s investigation consisted of LPA observation, record reviews, and interviews with residents, staff and outside sources.

Investigation revealed that Resident 1 (R1) moved into the facility on January 1, 2024. R1 was admitted and enrolled to receive hospice care on the same date. Facility staff stated that R1 was independent and did not require assistance with most ADLs. Records and interviews revealed on or about 01/04/2024, R1 presented symptoms of a change in condition. Staff observed R1’s foley catheter was leaking. R1 expressed pain when

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024

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 3

Control Number 08-AS-20240117151816

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SOLARIS 48	FACILITY NUMBER: 374603816
	VISIT DATE: 01/25/2024

NARRATIVE

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urinating. This was reported to hospice nurses. On 01/09/2024, R1 complained of bleeding from their genitals. Additionally, staff observed R1 to have slurred speech, vomiting and diarrhea. Interviews and records show that facility staff notified R1’s family, hospice agency and the licensee. An outside agency responded to the facility and began administering R1 comfort care. Subsequent records indicate R1 was weak, unable to thrive and had no appetite. Record reviews and interviews revealed that R1 passed away while receiving hospice services on 01/19/2024.

A sample of residents were interviewed. Interviewed residents were cognizant, organized, and able to communicate with LPA. Residents advised LPA that they are satisfied with the responsiveness of staff. Residents reported no evidence of abuse or staff not affording them dignity. Residents said they receive their medications in a timely fashion and had no complaints regarding receiving incontinence care or assistance with any Activity of Daily Living (ADL). The residents have not received complaints from other residents, nor have they witnessed any of the aforementioned allegations. Residents reported no complaints about anything related to the facility.

Staff interviews outlined the procedures staff follow when providing resident’s incontinence care. Staff are required to change residents at least four times a day when hospice providers come to the facility and administer care. Staff change resident undergarments and check for skin breakdown. As a practice, the facility staff does not document resident undergarment changes in the resident’s progress notes. However, outside source agency records did not show a lapse in incontinence care administered to residents. In regard to medications, staff denied making errors or delaying R1’s medications. R1 regularly took their medications but after 1/10/2024 began refusing them. Facility staff, as a practice, do not document when residents refuse to take their medications. Interviews revealed that on 1/11/2024, facility staff were directed by R1’s outside health services provider to hold certain medications due to R1’s change in condition.

Interviews with outside sources did not produce information to support the allegations. Outside agencies stated that they did receive cross reporting on the allegations in this complaint. No substantiated findings were determined by outside agency review of the allegations. LPA observation during a walk through of the facility did not show evidence that residents are not being changed regularly. Residents were fully dressed and showed no evidence to indicate they do not receive regular hygiene care and assistance. LPA observed no offensive odors; a common condition observed where residents are not receiving adequate toileting assistance.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240117151816

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SOLARIS 48	FACILITY NUMBER: 374603816
	VISIT DATE: 01/25/2024

NARRATIVE

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The Department has investigated allegations that staff did not assist a resident with incontinence care, did not administer medications as prescribed, did not treat resident with dignity, and did not report a change of condition of resident. Based on interviews and record reviews the investigation failed to produce sufficient evidence to prove or disprove the allegations. The preponderance of evidence standard was not met; therefore, the allegations are deemed unsubstantiated.

An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Caregiver/House Manager, Jushia Mendoza, whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024

LIC9099 (FAS) - (06/04)

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