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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 12/14/2022
Date Signed: 12/14/2022 04:53:46 PM

Document Has Been Signed on 12/14/2022 04:53 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: 2DATE:
12/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:ADMINISTRATOR, MANUEL VASQUEZ.TIME COMPLETED:
10:38 AM
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On December 14, 2022, Licensing Program Analyst (LPA), Venus Mixson, conducted an unannounced visit to the facility to conduct a case management Health and Safety visit. LPA Mixson met with Administrator, Manuel Vasquez introduced self and stated the purpose of the visit.

LPA Mixson conducted a tour of the facility and observed that the facility is clean, has adequate food, utilities are on, and there is running water, as observed through restroom and kitchen area.

LPA Mixson did not observe any Health and/or Safety concerns at this time. There were no issues or concerns observed. LPA Mixson requested and received pertinent documents.

An exit interview was conducted a copy of this report, along with LIC 811, will be faxed/emailed to the Administrator.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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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