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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603419
Report Date: 12/28/2023
Date Signed: 12/28/2023 05:19:34 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/05/2022 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20221205141552
FACILITY NAME:CASA DEL SOL RTFFACILITY NUMBER:
374603419
ADMINISTRATOR:MANUEL VASQUEZFACILITY TYPE:
735
ADDRESS:1561 E MISSION RDTELEPHONE:
(442) 444-8156
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:4CENSUS: 2DATE:
12/28/2023
UNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Manuel Vazquez, Licensee/Administrator TIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff did not treat client with dignity and respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation listed above. LPA met with Licensee Manuel Vazquez and explained the purpose of the visit, and the elements of the allegations.

The investigation consisted of observations, interviews, and record review. On 03/28/2022, the RO received a video depicting physical abuse of a client. During the course of the investigation for the physical abuse, additional videos were discovered. One video revealed Client 1 (C1) sitting on the floor in a bedroom slapping their own ears. Staff 1 (S1) is heard telling C1 to keep doing that while a female voice is heard laughing in the background. C1 continues to slap their ears. A second video shows C1 sitting on a sofa that is up against a wall. S1, Staff 2 (S2), and Staff 3 (S3) are seen picking up one end of the sofa. The end of the sofa is raised until C1 rolls off the sofa and onto the floor. Based on review of video, interviews conducted and records review, the preponderance of evidence standard has been met.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023
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 18-AS-20221205141552
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CASA DEL SOL RTF
FACILITY NUMBER: 374603419
VISIT DATE: 12/28/2023
NARRATIVE
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Therefore, the above allegation of staff failed to treat client with dignity and respect is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6 & Chapter 3) is cited on the attached LIC 9099D).

A copy of this report, appeal rights, and 9099D were discussed and provided to the Licensee/ Administrator.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20221205141552
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CASA DEL SOL RTF
FACILITY NUMBER: 374603419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2023
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: To be accorded dignity in his/her personal relationships with staff and other persons.
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The Licensee agrees to conduct an inservice on personal rights and what it means to treat client with dignity and respect. Proof of POC is to be submitted to the department by 5pm on the due date indicated.
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This requirement is not met as evidenced by review of 2 videos which revealed staff encouraging C1 to slap their ears and staff picking up sofa until C1 rolls off and to the ground. This posed an immediate health, safety and personal rights risk to C1.
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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.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3