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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 05/31/2022
Date Signed: 05/31/2022 03:08:27 PM

Document Has Been Signed on 05/31/2022 03:08 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:
05/31/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Diego Vazquez-La Madrid, DSPTIME COMPLETED:
03:10 PM
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On 5/31/22 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 Diego Vazquez-La Madrid, and explained the purpose of the visit.

At the time of the visit there was (1) staff and (3) clients present. There was 1 client that was still at the day program. 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 three clients present were inside of their bedrooms.

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 was provided to DSP Diego Vazquez-La Madrid.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2022
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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