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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 02/28/2024
Date Signed: 02/28/2024 05:19:07 PM

Document Has Been Signed on 02/28/2024 05:19 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
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:
02/28/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Manuel Vazquez, Licensee/AdministratorTIME COMPLETED:
04:35 PM
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On 02/28/24 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a health and safety check. LPA met with Licensee/Administrator Manuel Vazquez and explained the purpose of the visit.

At the time of the visit there was two (2) clients and one (1) staff present. Client #1 (C1) was inside their bedroom watching a television program. Client # 2 (C2) is from the sister facility #374604100 and observed to be sitting outside on the back porch. Client #3 was still at the program during LPAs visit.

During today's health and safety check LPA observed for there to be observed five (5) cans of mixed vegetables, two (2) boxes of mashed potatoes and 1 can of gravy to be expired. There was no citations issued as the expired items were discarded at the time of LPAs visit. After discarding the items, LPA observed for the facility to still have a sufficient food supply have a two day supply of perishable and a seven day supply of non-perishable food items.

The facility was observed to have working utilities (gas, water, electricity). LPA observed for the new cycle of medications to have been received and logged. The medications are locked and inaccessible to the residents in care.

An exit interview was conducted, and a copy of this report was provided to the Licensee/Administrator, Manuel Vasquez.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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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