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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601097
Report Date: 12/20/2021
Date Signed: 12/21/2021 08:43:15 AM

Document Has Been Signed on 12/21/2021 08:43 AM - 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:CASA DEL SOLFACILITY NUMBER:
374601097
ADMINISTRATOR:VIDA DACANAYFACILITY TYPE:
740
ADDRESS:4290 LAYLA WAYTELEPHONE:
(619) 662-1979
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY: 6CENSUS: 5DATE:
12/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Caregiver, Carmelita LaxamanaTIME COMPLETED:
05:25 PM
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced case management visit. LPA identified herself and stated the purpose of the visit to Caregiver, Carmelita Laxamana.

The facility self-reported an incident regarding Resident 1 (R1) to Community Care Licensing on 12/20/21. The facility reported that on 12/19/21, R1 left the facility (AWOL) unattended and has not returned to the facility. Facility staff filed a missing persons report.

On today’s date, LPA toured the facility and conducted a health and safety check. LPA briefly spoke with staff present at the facility and requested copies of R1 and facility records. No health or safety risks were observed and no deficiencies were cited at this time.

An exit interview was conducted with Caregiver Carmelita Laxamana, a copy of this report and the LIC9058 Licensee/Appeal Rights were provided via E-mai to Administrator, Vida Dacanay. An electronic read receipt verifies receipt of these documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2021
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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