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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 11/30/2023
Date Signed: 11/30/2023 11:53:35 AM

Document Has Been Signed on 11/30/2023 11:53 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
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:
11/30/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:ADMINISTRATOR, MANUEL VASQUEZTIME COMPLETED:
11:58 AM
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On November 30, 2023, Licensing Program Analyst (LPA), Venus Mixson made an unannounced visit to the facility for the purpose of conducting a health and safety check. LPA Mixson met with the Licensee, Manuel Vasquez, introduced herself, and explained the purpose of the visit.

LPA Mixson toured the facility along with the Licensee, currently at the time of this visit there were no staff and no resident presently observed at the facility.
Currently there are two residents who are at the Day Program.

LPA Mixson observed the facility's food supply which met the requirements two day supply of perishable and a seven day supply of non-perishable food items. The LPA observed a sufficient amount of personal protective equipment (PPE) supplies at the facility, and a sufficient amount of paper supplies (paper towels and toilet paper), for the amount of residents in care. The required postings were reviewed and in a highly visible location by the front door. The residents medications were locked and inaccessible to the residents in care. The facility was clean and free of clutter, the home had working utilizes, and all applicants were operable currently at the time of this visit.

LPA Mixson conducted a tour of the facility's interior and exterior, there were no Health and Safety violation or concerns observed currently at the time of this visit, and there were no Title 22, Division 6 Regulation violations observed, and/or cited at the time of this visit.

An exit interview was conducted, and a copy of this report was provided to the Licensee, Manuel Vasquez.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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