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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603419
Report Date: 05/01/2024
Date Signed: 06/14/2024 03:14:40 PM

Substantiated


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
12/01/2023 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20231201141945
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:
10:15 AM
MET WITH:Manuel Vazquez, Licensee/AdministratorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility staff are not dispensing resident's medication as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation noted above. LPA met with Licensee/Administrator Manuel Vazquez and explained the purpose of the visit and the elements of the allegation.

On 12/1/23 Community Care Licensing received a complaint alleging facility staff are not dispensing resident's medication as prescribed. Client #1 (C1) is diagnosed with a Neurological condition, as a result Pro Re Nata (PRN) medication was prescribed to be given as needed and received by the facility on June 15, 2023. The medication’s purpose is to treat the onset of symptoms associated with C1’s neurological condition. Per a records review C1 experienced symptoms or episode related to their condition on 11/12/23 and staff did not administer the prescribed PRN medication but instead called 911.
Per an interview with the Licensee/Administrator Manuel Vazquez the medication was not administered because “the prescription instructions were not clear”. The licensee did not make a request for training or make attempts from appropriate parties to obtain further clarification.
Substantiated
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 3
Control Number 18-AS-20231201141945
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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Based on observations, interviews and records review the allegation of facility staff are not dispensing resident’s medication as prescribed is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.
A citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 6) on the attached 9099D.

An exit interview was conducted and a copy of this report, appeal rights and LIC9098 was reviewed 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 3
Control Number 18-AS-20231201141945
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/02/2024
Section Cited
CCR
80074(4)(B)
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(4) If the client's physician has stated in writing that the client is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, staff shall be permitted to assist the client with self-administration of their PRN medication. (B)Once ordered by the physician
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There is no POC as the Licensee was contacted by a representative from the medication distribution company. An inservice was conducted on 12/20/23. LPA was provided the sign in sheet and verfied with the representative that the training was in fact given.
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 the medication is given according to the physician's directions. This requirement is not met as evidenced by: the licensee did not administered medication as prescribed 1 out of 1 times, which posed an immediate health safety and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3