<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 05/26/2022
Date Signed: 05/26/2022 06:43:26 PM

Document Has Been Signed on 05/26/2022 06:43 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:
05/26/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
06:25 PM
MET WITH:Jalisa Fore, DSPTIME COMPLETED:
06:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 5/26/22 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 met with DSP Jalisa Fore, and explained the purpose of the visit.

At the time of the visit there was (2) staff Jalisa Fore and Fernando Perez and (3) clients present. There was 1 client on a pass for the week with family. LPA observed the facility to be within the required ratio of 3:1. LPA conducted a tour of the facility, the facility was clean and clutter free. The two clients present at the facility Clients #1 was preparing lunch for tomorrow, Client #2 was in the shower and client #3 was coloring.

LPA observed the facility's food supply which met the requirements; 2 day supply of perishable and a 7 day supply of non-perishable food items.

No health and safety concerns were observed during the visit, therefore no citations were issued.

An exit interview was conducted, and a copy of this report and LIC811 was provided to Jalisa Fore.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1