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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603817
Report Date: 08/30/2022
Date Signed: 08/31/2022 01:42:50 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-20200303150851
FACILITY NAME:SOLARIS 34FACILITY NUMBER:
374603817
ADMINISTRATOR:REYES, KELEIGHFACILITY TYPE:
740
ADDRESS:14534 GARDEN RDTELEPHONE:
(844) 320-1497
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 5DATE:
08/30/2022
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Anafe Rivera, Site ManagerTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Licensee is interfering with residents’ right to select their own hospice agency.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Anafe Rivera, Site Manager, to whom LPA disclosed the reason for the visit.

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

It was reported to Community Care Licensing that the licensee interfered with residents’ right to select their own hospice agency. It was determined during the investigation that Resident 1 (R1) [LIC 811 Confidential Names List was provided to identify the resident] received services from a few hospice agencies during the last 1.5 to 2 years of residing in the facility. The investigation yielded that R1’s responsible party was presented with the opportunity to elect whether R1 would be enrolled in hospice
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: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
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 5
Control Number 08-AS-20200303150851
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 34
FACILITY NUMBER: 374603817
VISIT DATE: 08/30/2022
NARRATIVE
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services. However, R1’s responsible party was not presented with the opportunity to select which hospice agency would provide services to R1. The investigation yielded evidence that R1’s responsible party was not presented with options or given an opportunity to participate in the agency selection process. R1’s responsible party was informed, by facility staff, of which hospice agency R1 would be enrolled into and would provide services. R1’s responsible party was only provided paperwork to sign to have R1 admitted into hospice services once the agency had been selected by facility personnel.

Based upon interviews conducted, the above allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. Deficiency is 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 Anafe Rivera, Site Manager, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to the Site Manager at the conclusion of the visit. Her 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: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
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
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-20200303150851

FACILITY NAME:SOLARIS 34FACILITY NUMBER:
374603817
ADMINISTRATOR:REYES, KELEIGHFACILITY TYPE:
740
ADDRESS:14534 GARDEN RDTELEPHONE:
(844) 320-1497
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 5DATE:
08/30/2022
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Anafe Rivera, Site ManagerTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Licensee is not meeting resident's incontinent care needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Anafe Rivera, Site Manager, to whom LPA disclosed the reason for the visit.

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

It was reported to Community Care Licensing that facility staff were not meeting the incontinent care needs of Resident 1 (R1). It was alleged that R1was repeatedly found to be wet when visited by outside sources. Interviews of R1 and other outside sources who regularly visited with R1 in the facility did not reveal evidence to support the allegation.

Unsubstantiated
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: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
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-20200303150851
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 34
FACILITY NUMBER: 374603817
VISIT DATE: 08/30/2022
NARRATIVE
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Based upon a lack of evidence to corroborate the above listed allegation, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Anafe Rivera, and copies of this report and Licensee/Appeal Rights (LIC 9058) were provided to the Site Manager at the conclusion of the visit. Anafe Rivera’s signature on this report 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: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20200303150851
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 34
FACILITY NUMBER: 374603817
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2022
Section Cited
CCR
87468.2(a)(18)
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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 . . .
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Site Manager 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 9/27/2022.
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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 5 residents in care to select their own hospice agency. This posed a potential personal rights risk to residents in care.
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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: 08/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5