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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 11/04/2022
Date Signed: 11/04/2022 04:35:32 PM

Document Has Been Signed on 11/04/2022 04:35 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: DATE:
11/04/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
04:14 PM
MET WITH:Licensee/ Administrator, Manuel VasquezTIME COMPLETED:
04:45 PM
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On 11/04/2022 at 4:14 p.m. Licensing Program Analyst (LPA) Janira Arreola made an unannounced visit at the facility for the purpose of conducting a health and safety check. LPA Arreola met with licensee Manuel Vasquez and explained the purpose of the visit.

At the time of the visit there was (2) staff and (2) client present. LPA observed the facility to be within the required ratio of 3:1. LPA conducted a tour of the facilities interior and exterior. LPA walked through back yard, garage, kitchen, living room, activity room, and clients bedrooms and bathrooms. The facility has (4) bedrooms and (2) bathrooms. The facility was observed to be clean and free of clutter. Client #1 (C1) was asleep in their bedroom and Client #2(C2) was in their room. (2) rooms are vacant, and (2) rooms are occupied.

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. LPA observed a sufficient amount of PPE supplies at the facility. LPA observed clients medications and observed at least a 30 day supply. LPA observed a sufficient amount of paper supplies (paper towels and toilet paper), in the facility garage.

LPA requested and received copies for the staff schedule.

No health and safety concerns were observed during the time of the visit.

An exit interview was conducted, and a copy of this report was provided to Licensee/ Administrator Manuel Vasquez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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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