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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 11/20/2023
Date Signed: 11/20/2023 10:27:16 AM

Document Has Been Signed on 11/20/2023 10:27 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
RIVERSIDE ASC, 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:
11/20/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Manuel Vazquez, Licensee TIME COMPLETED:
09:30 AM
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On today's date 11/20/23, Licensing Program Analyst (LPA) Javina George made an unannounced visit at the facility for the purpose of conducting a health and safety check. LPA met with the licensee Manuel Vasquez, and explained the purpose of the visit.

At the time of the visit there was (1) staff and (1) client present. LPA observed the facility to be within the required ratio of 3:1. Client # 1 (C1) was at the home in their bedroom, waiting to be transported to the day program. Client #2 (C2) was at the day program. The home currently has two (2) vacant rooms, and two (2) rooms that 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 personal protective equipment (PPE) supplies at the facility. LPA observed a sufficient amount of paper supplies (paper towels and toilet paper), for the amount of clients in care. The client medications were accounted for

LPA conducted a tour of the facility's interior and exterior, there were no health and safety concerns observed.

An exit interview was conducted, and a copy of this report was provided to Licensee, Manuel Vasquez.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
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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