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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 05/23/2024
Date Signed: 05/23/2024 05:06:55 PM

Document Has Been Signed on 05/23/2024 05:06 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:
05/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:52 PM
MET WITH:Mnauel Vazquez, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On 5/23/24 Licensing Program Analyst (LPA) Javina George made an unannounced case management incident visit in regards to an unusual/injury report regarding for Client #1 (C1) as they sustained a fracture.

LPA conducted a records review (body map, client daily reports, staff schedule), interview with the Licensee/Administrator and attempted other interviews with facility staff and third party witnesses. LPA was unable to interview C1 as they were asleep during LPAs visit.

Current care plan: A bone density scan was conducted on 5/23/24, and C1 will follow up with their Primary Care Physician and Psychiatrist within the next 2-3 days to discuss the results of the scan. C1 was ordered and is currently wearing a boot. The department will conduct a follow up visit in regards to the matter and issue any citations if found that the facility failed to seek medical attention in a timely manner.

An exit interview was conducted and a copy of this report was reviewed and provided to Licensee/Administrator Manuel Vazquez.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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