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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604624
Report Date: 01/06/2023
Date Signed: 01/06/2023 02:21:02 PM

Document Has Been Signed on 01/06/2023 02:21 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SOLUNA WELLNESSFACILITY NUMBER:
374604624
ADMINISTRATOR:HERNANDEZ, ANTONIOFACILITY TYPE:
775
ADDRESS:1419 UNIVERSITY AVETELEPHONE:
(619) 395-4573
CITY:SAN DIEGOSTATE: CAZIP CODE:
92103
CAPACITY: 30CENSUS: 0DATE:
01/06/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator Antonio HernandezTIME COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Kayla Hilario, conducted an announced Pre-Licensing inspection. LPA identified herself, disclosed the purpose of the visit, and met with Administrator Antonio Hernandez.

LPA conducted a tour of the physical plant. The adult day program facility is located within a strip mall area and there is no designated outdoor space or no pools of water on site. The smoke and carbon monoxide alarms were present. Toilets intended for client use were operating as intended. The windows, blinds and paint throughout the facility, was observed in good condition. Each area intended for client use had the appropriate furniture for a day program and appropriate lighting. Administrator Hernandez stated there are no firearms stored on the premises.

The facility was observed to be clean and kempt with no strong malodors. The facility will not administer medications. No bathrooms shall be used for personal grooming by clients. The water temperature in the men's bathroom read at 124 degrees Fahrenheit and the women's bathroom at 61 degrees Fahrenheit. The refrigerator was observed to be clean and operational however, clients will bring there own food daily. Cleaning solutions were also properly secured and locked in a closet.

The Component III portion of the application process was completed with Hernandez on today's date as well.
The facility does not have evacuation chairs for each stairwell as required by Health and Safety Code Section 1565(f)(1). Further, the fire clearance needs to be updated to an ADP and not an ARF. Finally, room temperature was not able to measured due to not having a working thermometer which will be added or fixed.
Pre-Licensing is incomplete with deficiencies to be resolved by January 27, 2023. An exit interview was conducted with Administrator Antonio Hernandez to whom a hardcopy of this report and Appeal/Licensee rights (LIC9058 01/16) were provided via hardcopy at the conclusion of the visit.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Kayla Hilario
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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