Solaris 28

Allegation investigated: Licensee has abandoned the facility. Licensee has lost control of property. Licensee did not report sale of facility.

Licensing Program Analyst (LPA) Liliana Silveira conducted a virtual meeting on Microsoft Teams with Licensee Xiaoqing “Leslie” Wang to deliver complaint findings. LPA stated the purpose of the meeting with Leslie. The investigation consisted of observations, interviews and a records review. On January 30, 2025, it was alleged that the Licensee had abandoned the facility. A Licensing Program Analyst (LPA) from the Department conducted an unannounced Health & Safety check on January 31, 2025. The LPA observed that there were caregivers present, changing residents and preparing dinner for the residents. The LPA also observed that the facility was clean. Interviews with the current acting Administrator revealed that in June 2024, two Administrators had quite and left the residents with care staff. Interviews with three (3) care staff who worked at the facility during June 2024, revealed that even though the Administrators quit, care staff remained working at the facility until the Licensee came soon after to manage the facility. (CONTINUED ON NEXT PAGE, LIC 9099-C) Unsubstantiated (CONTINUED FROM PAGE LIC 9099) An interview with the Licensee revealed that in June 2024, as soon as they were informed that the Administrators quit, the Licensee returned to the facility to check on the residents and manage the facility. There was not enough evidence to support this allegation. It was also alleged that the Licensee had lost control of the property and did not report the sale of the property. A records review revealed that a Property Management Agreement provided by the Licensee, dated September 20, 2019, and with expiration date of September 20, 2029, demonstrated that the property is leased to Solaris Capital Group Inc. An interview with the Licensee revealed that they still act as property manager for the property via Solaris Capital Group Inc. The interview also revealed that the property owner has no intention of selling the property at this moment. An interview with the current Administrator, who represents a new management group, revealed that they are in current negotiations with the Licensee/Property Manager to take over the lease and have applied for a license with Community Care Licensing Division. There was not enough evidence to support these allegations. The allegations that the Licensee had abandoned the property, had lost control of the property and did not report the sale of the property are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations occurred, therefore the allegations are unsubstantiated. LPA Silveira conducted an exit interview with Leslie. A copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 03/22) were provided via email. Confirmation via email by Linda confirms receipt of this report.the state’s words, verbatim · CDSS document, Jun 9, 2025 · control 08-AS-20250130151822

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Amy Rodgers conducted an Case Management visit to respond to observations and interviews from a visit conducted on 3/14/2025. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Jushua "Justin" Mendoza. During today’s visit, LPA observed Staff #1 open a non-locking drawer in the facility’s kitchen, which contained the keys to the locked medication cabinet and proceed to unlock mediation cabinet. LPA also interviewed the administrator and he explained the open non-locking facility kitchen drawer is where the keys are normally stored. After the observation was made LPA was able to observe Staff#1 place keys in their pocket and LPA advised Staff#1, as well as the administrator, keys to the centrally stored medication cabinets should never be made accessible to clients or guests in the home. Based on the inspection, deficiencies were observed in the areas evaluated, and observed deficiencies are listed on the LIC 809-D pages. An exit interview was conducted, and this report was discussed with Administrator Mendoza. A copy of this report and Licensee/Appeal Rights (01/2016) were provided to the Administrator at the conclusion of the visit, and his signature on this form acknowledges receipt of the rights and a copy of this report.the state’s words, verbatim · CDSS document, Mar 14, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Apr 14, 2025

87465 Incidental Medical and Dental Care: “(h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.” This requirement was not met, as evidenced by: Based on LPA observation, Licensee did not ensure that centrally stored medicines were kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This posed an immediate health and safety risk to 6 of 6 residents (R1 through R6) in care.the state’s words, verbatim · CDSS document, Mar 14, 2025

Plan of correction: During today's visit, LPA observed employee remove keys from kitchen drawer and keep on their person. This resolved the immediate risk. Licensee agreed to retrain all current staff on expectations regarding safe storage of centrally stored medications, and to E-mail the training sign-in sheet to LPA by 04/14/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Case Management visit to respond to observations and interviews from a visit conducted on 2/08/2025. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Jushua "Justin" Mendoza. During visits on 2/08/2024 and 2/26/2025, LPA toured the facility and observed resident in care. During the facility tour on 2/08/2025, LPA observed resident's medications were stored in medication cups, cups were stored in a sectioned off plastic container with daily times for medication and not in their original container. LPA explained to Administrator Mendoza that they were to immediate stop pre-pouring medications and dispense medication according to (community care licensing (CLL) guidelines. (Continued on 809-C) (Continued form 809) On 2/08/2025 LPA observed a pathway exiting from kitchen to common backyard blocking access to residents in care. Pathway was blocked by washer and dryer placed outside the common backyard exit/entrance door. On 2/08/2025 LPA Observed uneven threshold in three doorways,(bathroom # 1 and Bedroom #4 and #5) bathroom #1 sink was not draining, cobwebs in all bathrooms and all bedrooms. All resident doors had fingerprints and splotches of dirt. All Bathroom shelves have brown splotches and brown spots. The kitchen cabinets had inside and outside debris/dirt and grease. The oven vent was greasy and had debris/dirt. The back yard shed was in disrepair and had a door hanging to the side. The back yard fence in disrepair: missing pieces of fence and lattice is hanging off top of fence. Based on the inspection, deficiencies were observed in the areas evaluated, and observed deficiencies are listed on the LIC 809-D pages. An exit interview was conducted, and this report was discussed with Administrator Mendoza. A copy of this report and Licensee/Appeal Rights (01/2016) were provided to the Administrator at the conclusion of the visit, and his signature on this form acknowledges receipt of the rights and a copy of this report.the state’s words, verbatim · CDSS document, Feb 26, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(5) · Plan of correction due date: Feb 26, 2025

87465 Incidental Medical and Dental Care (h) The following....medications which are centrally stored: (5) Each resident's medication...stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Based on LPA observation, the licensee did not comply with the section cited above in that 4 of 5 [R1,R2,R3, R4, R5] resident's medications are stored in a medication cups, which poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Feb 26, 2025

Plan of correction: LPA spoke with Administered on 2/7/2025 regarding the pre-pour of medications. LPA instructed Administrator to cease immediately the pre-pouring of medications and to instruct caregivers to give resident medications directly from the pill bottle and not from the pillbox and to not pre-pour medication.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Mar 12, 2025

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance... for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observations, the licensee did not ensure the facility was in good repair for 5 out of 5 [R1-R5] residents, due to uneven threshold in two doorways, bathroom sink not draining, cobwebs in bathrooms and bedrooms, inside and outside debris/dirt and greasy cabinets, greasy debris/dirt stove vent, back yard shed in disrepair, back yard fence in disrepair which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 26, 2025

Plan of correction: LPA spoke as well as toured the property with Administrator on 2/7/2025. Administrator was instructed by LPA to clean and repair the inside of the facility as well as the repair of backyard fencing and outside storage shed. LPA observed a clean and in good repair facility on 3/12/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(d)(6) · Plan of correction due date: Feb 26, 2025

(d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This was evidenced by: Based on observation ,the licensee did not ensure the facility passageways were kept free from obstruction for X of X [R1-R5] residents, due to the washer and dryer placed outside the common backyard exit/entrance door, the licensee did not comply with the section cited above in which posed a potential health and safety risk to xx persons in care.the state’s words, verbatim · CDSS document, Feb 26, 2025

Plan of correction: LPA spoke as well as toured the property with Administrator on 2/7/2025. Administrator was instructed by LPA to clean area and remove the washer and dryer outside the common backyard exit/entrance door. LPA observed the exit/entrance clear from obstructions on 2/26/2025.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Case Management visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Justin Mendoza, Administrator& Arceli Songco, Administrator LPA briefly toured the facility, performed a health and safety welfare check. There are 6 residents at this facility at this time. LPA Rodgers spoke with staff and residents. No deficiencies were observed or cited on this date. An exit interview was conducted with Arceli Songco, Administrator to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Feb 26, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Case Management visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Justin Mendoza, Administrator. LPA briefly toured the facility, performed a health and safety welfare check. There are four residents at this facility at this time. LPA Rodgers spoke with staff and residence. No deficiencies were observed or cited on this date. No heath and safety concerns at this time. An exit interview was conducted with Justin Mendoza, Administrator, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Feb 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Anafe Rivera. According to the facility’s license, the facility has a maximum capacity of six (6) residents, of whom six (6) may be non-ambulatory. During today’s inspection, there were a total of six (6) clients in care. This facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by Anafe Rivera, toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperature at taps accessible to clients were all compliant. There was at least 2 days supply of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters observed available to clients. Medications were labeled, as required, and stored in locked areas. (CONTINUED ON LIC809-C) (CONTINUED FROM LIC809) No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Confidential records were stored in locked areas. Anafe Rivera also presented proof of current/active business liability insurance. No deficiencies were observed or cited during today's annual inspection.. An exit interview was conducted with Anafe Rivera to whom a copy of this report and the Licensee/AppealRights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, May 9, 2024

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit to conduct a Health & Safety Welfare Check. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Site Manager Anafe Rivera. During today’s visit, LPA performed a facility tour / welfare check, collected and reviewed select resident care records, and interviewed staff. Staff interviews corroborated to show: a) On 02/10/2024 during the overnight shift, Resident #1 (R1) closed the drain of their sink in their private bathroom, and then let the sink faucet run continuously. [See LIC811 Confidential Names List for a description of person identifiers use in this report.] Staff, who were not required to be awake at this time, were not immediately aware of the problem. The result was that water spilled onto the facility’s floor, flooding R1’s bedroom, two adjacent bedrooms and their corresponding bathrooms, and one edge of the facility’s dining room. Multiple staff spent a few hours cleaning up the water. None of the facility’s residents needed to be relocated. Per LPA review of CCLD’s database, the Department did not receive a written report from Licensee describing this incident, as was required to be submitted within seven (7) days of occurrence. b) On 02/16/2024, R1 passed away at the facility, under the concurrent care of a hospice agency. Per LPA review of CCLD’s database, the Department did not receive a written report from Licensee describing R1’s death, as was required to be submitted within seven (7) days of occurrence. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] During records review, LPA observed, and staff interviews confirmed: Licensee did not possess a written Absentee Notification Plan (or an equivalent missing resident policy) as part of the written record of care for R1 or any of the five (5) current residents of the facility. Licensee did not possess written evidence of a negative Tuberculosis (TB) test result for Resident #2 (R2), which was required before they moved in. Also, two (2) residents, Resident #3 (R3) and Resident #4 (R4), were formally diagnosed with dementia. However, LPA observed that Licensee’s staff had manually turned off / disabled staff alert devices on its exterior doors. Four (4) deficiencies were cited per California Code of Regulations, Title 22, and one (1) deficiency was cited per California Health and Safety Code (refer to the attached LIC 809-D pages). Plans of Correction was jointly developed with the Licensee. An exit interview was conducted with Rivera, to whom a copy of this report, the LIC 809-D pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Mar 20, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Apr 19, 2024

87211 Reporting Requirements: "(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency…within seven days of the occurrence of any of the events specified...(D) Any incident which threatens the welfare, safety or health of any resident." This requirement was not met, as evidenced by: Based on records and interviews, there was an incident which threatened their welfare of 6 of 6 residents (R1 through Resident #6), and Licensee did not submit a written incident report for it to the licensing agency within seven days of incident occurrence. This posed a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 20, 2024

Plan of correction: Licensee agreed to compose an LIC624 Incident Report describing the February 2024 sink-flooding incident, and to send a copy of the LIC624 to the CCLD San Diego Regional Office (CCLASCPSanDiegoRO@dss.ca.gov). Licensee agreed to utilize a third-party source to retrain its facility managers on Regulation 87211 Reporting Requirements. Licensee agreed to E-mail LPA the training sign-in sheet by the POC due date. Licensee also agreed to arrange for a third-party licensed mold inspector to examine the facility and provide a formal recommendation as to whether remediation repairs are required. Licensee agree to E-mail the mold inspector's report to LPA, by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(A) · Plan of correction due date: Apr 19, 2024

87211 Reporting Requirements: "(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency…within seven days of the occurrence of any of the events specified...(A) Death of any resident from any cause regardless of where the death occurred…” This requirement was not met, as evidenced by: Based on records and interviews, Licensee did not submit a written report to notify the licensing agency of the death of 1 of 6 residents (R1) in care, within seven days of their death. This posed a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 20, 2024

Plan of correction: Licensee agreed to compose an LIC624A Death Report describing R1’s death and the circumstances leading up to it, and to send a copy of the LIC624A to the CCLD San Diego Regional Office (CCLASCPSanDiegoRO@dss.ca.gov). Licensee agreed to utilize a third-party source to retrain its facility managers on Regulation 87211 Reporting Requirements. Licensee agreed to E-mail LPA the training sign-in sheet by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.317 · Plan of correction due date: Apr 19, 2024

1569.317 Absentee Notification Plan for Missing Residents: “Every residential care facility for the elderly…shall…develop and comply with an absentee notification plan…The plan shall include…a requirement that an administrator of the facility, or his or her designee, inform the resident’s authorized representative when that resident is missing from the facility…and the circumstances in which [they] shall notify local law enforcement.” This requirement was not met, as evidenced by: Based on records and interviews, licensee’s staff did not develop an absentee notification plan for 6 of 6 residents (R1 through Resident #6), which posed a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 20, 2024

Plan of correction: Licensee agreed to write an Absentee Notification Plan/policy meeting the requirements of CA H&S Code 1569.317, and to train all its staff on it. Licensee also agreed to place a copy of said Absentee Notification Plan in the care file for every current and future client in care, right next to (i.e., as an addendum to) that client’s Needs and Services Plan. Licensee agreed to E-mail the Plan and the training sign-in sheet to LPA, by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87705(j) · Plan of correction due date: Apr 19, 2024

87705 Care of Persons with Dementia: “(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.” This requirement was not met, as evidenced by: Based on records and interviews, during today’s visit, Licensee did not have continuously active auditory devices or other staff alert features to monitor exits, which posed a potential safety risk to 2 of 5 residents (R3 and R4) in care.the state’s words, verbatim · CDSS document, Mar 20, 2024

Plan of correction: During today’s visit: Licensee activated (turned on) the auditory alarms at each exterior door (other than the lobby front door). Licensee agreed to retrain its staff to keep all such alarms activated 24/7. Licensee agreed to E-mail a copy of the staff training sign-in sheet to LPA, by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(b)(1) · Plan of correction due date: Apr 19, 2024

87458 Medical Assessment: “(b) The medical assessment shall include…: (1) A physical examination of the resident…and results of an examination for communicable tuberculosis…” This requirement was not met, as evidenced by: Based on records review and manager interview: Licensee did not ensure that the medical assessment for 1 of 5 residents (R2) included the results of an examination for communicable tuberculosis, which posed a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 20, 2024

Plan of correction: Per staff interviews and corroborated by LPA observation, R2 has not recently shown any symptoms consistent with tuberculosis (TB). Licensee agreed to coordinate with R2’s physician and/or responsible party, as needed, to have R2 tested for tuberculosis. Licensee agreed to place written proof of a negative TB test result in R2’s care chart, and to E-mail a copy of the proof to LPA, by the POC due date. Licensee also agreed to retrain all facility staff who are directly involved with the admissions/move-in process on Regulation 87458, titled “Medical Assessment,” and to submit the training sign-in sheet to LPA, by the POC due date.