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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 04/28/2022
Date Signed: 04/28/2022 04:16:18 PM

Document Has Been Signed on 04/28/2022 04:16 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
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: 4DATE:
04/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Manuel Vazquez, Administrator TIME COMPLETED:
04:20 PM
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On 4/19/22 Licensing Program Analyst (LPA) Javina George made an unannounced visit at the facility for the purpose of conducting a health and safety check. LPA George was greeted and granted entry by staff Diego Vasquez-Lamadrid, and Licensee/Administrator Manuel Vazquez, LPA explained the purpose of the visit. At the time of the visit there were (1) staff and (3) clients present. 1 client was still at the day program.

LPA observed the facility to be clean and clutter free. LPA observed the facility to have the required amount of food, 2 day supply of perishable and a 7 day supply of non-perishable food items. Dinner (past) was being served prepped.

LPA George reviewed and was provided with a copy of the facility's staff schedule. The facility was within the required ratio (3:1) at the time of LPAs visit.

LPA observed all three clients present to be (1) was laying down in bed, and (2) were outside on the swing and walking around in the backyard.

No physical signs of distress or concern were observed, no health and safety concerns were observed at the time of the visit.

An exit interview was conducted, and a copy of this report was provided to Licensee/Administrator Manuel Vasquez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
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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