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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 09/15/2022
Date Signed: 09/15/2022 10:22:05 AM

Document Has Been Signed on 09/15/2022 10:22 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:
09/15/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Fernando Perez - StaffTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Crystal Colvin conducted an unannounced visit to the facility for the purpose of a health and safety check. LPA Colvin met with facility staff Fernando Perez, who was informed of the purpose of the visit.

At the time of the visit there was (1) resident and (1) staff present. LPA Colvin observed the facility to be within the required ratio of 3 to 1. LPA Colvin conducted a tour of the interior and exterior of the facility, and checked the facilities paper supply, medications, PPE supplies, and food supplies. LPA Colvin observed that these items were in sufficient numbers for the amount of residents at the facility.

LPA Colvin observed Resident (R1) asleep in their bedroom. The facility's second resident (R2) was out at Day Program during LPA Colvin's visit. No immediate health and safety concerns were observed at this time.

An exit interview was conducted where this report was reviewed and provided to facility staff Fernando Perez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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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