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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 05/01/2024
Date Signed: 05/01/2024 01:04:05 PM

Document Has Been Signed on 05/01/2024 01:04 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/
DIRECTOR:		MANUEL VASQUEZFACILITY TYPE:
735
ADDRESS:1561 E MISSION RDTELEPHONE:
(442) 444-8156
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 4CENSUS: 3DATE:
05/01/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Manuel Vazquez, Licensee/Administrator TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Javina George conducted a health and safety check. At the time of the visit was one (1) staff and (0) resident's present as the residents were at the day program.

During today's health and safety check LPA observed for the facility food supply to be sufficient as there was a 2 day supply of perishable and a 7 day supply of nonperishable food items. The facility was observed to have working utilities (gas, water, electricity). The medications are locked and inaccessible to the residents in care. The facility has a supply of hygiene products such as soap and shampoo for the residents to use.

The facility was granted the health and safety waiver on 4/18/24, and Client #1 (C1) official move from home #2 to this facility is official today 5/1/24.

The following was discussed during today's visit with the Administrator:
-Associating S1 to the facility by 5pm today 4/18/24-complete
-Cleaning the window sills to remove the dust and cobwebs that were observed-complete
-Having a copy of the program design available at the facility to review-complete
-Follow up regarding medications that are needed for the residents at the day program-complete
-Enroll in an upcoming Home and Community Based Services (HCBS) Final Rule training-no updates were provided. Licensee will follow up with placing agency.

Based on today's health and safety concerns were observed.

An exit interview was conducted, and a copy of this report, form was provided to the Licensee/Administrator, Manuel Vasquez.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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