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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603419
Report Date: 05/23/2025
Date Signed: 05/23/2025 01:56:19 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
10/29/2024 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20241029084032
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:
05/23/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Manuel Vasquez, Licensee/AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not ensure client's room was kept free of hazards.
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 listed above. LPA met with Manuel Vazquez, Licensee/Administrator and explained the purpose of the visit and the elements of the allegations. The allegation was investigated, and the investigation consisted of observations interviews and records review.

On 10/29/2024 Community Care Licensing received a complaint alleging that Staff did not ensure client's room was kept free of hazards. This was alleged due to Client #1 (C1) being observed to have a red mark around their neck on or around 10/22/24. Regarding the allegation LPA conducted a review of records (Individual Program Plan dated April 2023) which revealed that C1 does have a history of property destruction, and self-injurious behaviors that are described as “physical aggression towards self of hitting their head, arms, legs with hand or closed fist”. LPA reviewed C1’s October 2024 behavior log which is used to track C1’s physical aggression, self-injurious behaviors, and property destruction. The log revealed that on 10/22/24, there was one instance logged as “1”, however, it was clearly written over
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
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-20241029084032
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: 05/23/2025
NARRATIVE
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a previous entry of “0”. LPA interviewed C1 however, C1 would not tell LPA how they obtained the mark on their neck. C1 did admit to having a wire while they were in their room. Per an Interview with Licensee Vazquez indicated it is unknown where the wire came from and that C1 wrapping items around their neck is a new self-injurious behavior.

On 10/302/24 the initial compliant visit LPA conducted a brief visual check of C1’s room for any potential hazardous items. LPA did not observe any at the time, however during the visit facility staff showed several potentially hazardous items to LPA including a screw, zip tie, and 2 small/metal brackets that were found inside C1’s dresser drawer.

Based on observation and interviews the allegation of staff did not ensure client’s room was kept free of hazards 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.

An exit interview was conducted and a copy of this report, 9099D, appeal rights, and LIC811-confidential names list was provided to Licensee Manuel Vazquez.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-AS-20241029084032
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: 05/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/06/2025
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by: the Licensee did not ensure C1s room was free from
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The licensee agrees to have facility staff conduct daily check/search log of C1s room for any potentially hazardous items. No POC due at this time as the safety checks and log was implemented 10/2024.
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hazards as there was zip tie, screw and 2 silver metal brackets in C1s room, 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: Anthony Perez
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3