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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603419
Report Date: 05/01/2024
Date Signed: 05/01/2024 01:18:54 PM

Unsubstantiated


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
04/21/2022 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220421155241
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: 3DATE:
05/01/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Manuel Vazquez, Licensee/Administrator TIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Client had an unexplained shoe print on their back.
INVESTIGATION FINDINGS:
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Licensing Program Analyst LPA Javina George arrived at the facility unannounced to deliver findings for the allegation listed above. The investigation consisted of interviews and records review. With recent events of abuse being brought to the attention of the department, that occurred at the sister facility #374604100, an investigation was launched into all complaints and incidents that suspect possible abuse.

On 04/21/22 Community Care Licensing received a complaint alleging that in around December 2012 Client #1 (C1) had an unexplained shoe print on their back. Documentation (picture) reviewed confirmed that C1 did in fact have a shoe print directly on their back. The shoe print was located in the upper part in the middle of C1’s shoulder blades. The shoe print design can be described as a waffle print. C1’s back was photographed with a visible mark on C1’s resembling a shoe print. An internal investigation was conducted by a third-party witness. The investigation included a meeting with C1’s treatment team and the location of the incident could not be pinpointed, as to where C1 would have gotten the shoe print on
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
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 2
Control Number 18-AS-20220421155241
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: 05/01/2024
NARRATIVE
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the C1s back. Per interviews with a third party witness a special/unusual injury report and or notes from the meeting that was held was not in C1's file for review. C1 attended a local day program as well as resides at the home, at the time of the incident the facility was licensed as a group home.

Furthermore, per Licensee at the time of the incident, the day program was contacted during this time frame and found that there were no reports or observations noted that detail any incidents that occurred with C1 that might have caused C1 to have a shoe print on the back.

C1 was unable to be interviewed due to communication barriers. The allegation that a resident had unexplained shoe print on their back is found to be unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted and a copy of this report was discussed and provided to Licensee/Administrator Manuel Vazquez.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2