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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 07/14/2022
Date Signed: 07/14/2022 11:18:49 AM

Document Has Been Signed on 07/14/2022 11:18 AM - 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: 2DATE:
07/14/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Fernando PerezTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Janira Arreola made an unannounced visit to the facility for the purpose of a health and safety check. LPA was greeted and granted entry by staff member Fernando Perez, who was informed of the purpose the visit.

At the time of the visit there was one client (C1) and 1 staff member present. LPA observed the facility to be within the required ratio of 3:1. LPA toured the interior and exterior of the facility. LPA observed the clients medication in locked medication cabinet to be within the 30 day supply. LPA observed C1 in their room sleeping, while C2 was not observed at the facility. Staff informed LPA that C2 was at their day program. LPA observed the kitchen for the required 2-day perishable and 7-day non-perishable foods. LPA observed that this requirement was met. LPA observed the restrooms and client rooms. There are currently (2) rooms that are vacant and (2) rooms that are occupied. LPA observed facility restroom to have toilet paper and the necessary hygiene supplies. LPA observed the facilities paper supply, and 30-day PPE supply.

There were no health and safety issue observed during the time of the visit.

No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided to facility staff, Fernando Perez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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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