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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 08/29/2024
Date Signed: 08/29/2024 10:30:40 AM

Document Has Been Signed on 08/29/2024 10:30 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/
DIRECTOR:
MANUEL VASQUEZFACILITY TYPE:
735
ADDRESS:1561 E MISSION RDTELEPHONE:
(442) 444-8156
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 4CENSUS: 2DATE:
08/29/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Manuel Vazquez, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
09:40 AM
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On 08/29/24 at 8:55am, Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a health and safety check. At the time of the visit was one (1) staff and (0) clients present, as they were at the day program. The facility census has changed as Client #1 (C1) was discharged from the facility on Monday 08/26/24.

During today's health and safety check LPA conducted an overall status of the facility. LPA verified that items listed on the facility's Technical Assistance Plan dated 7/15/24 was reviewed:
-making any necessary repairs to the deck-completed
- Home and Community Based Services (HCBS) final rule training-completed, the facility is HCBS compliant as of 08/14/24
-Personal and Incidental cash training (P&I)- completed on 07/19/24
-Perishable food item training-completed on 07/18/24
-Client rights training completed on 07/07/24
- A meeting with the treatment team in regards to the window and safety vinyl covers-completed on 07/17/24

The medications were observed to be locked and inaccessible to the clients in care. Medications were reviewed and present and are being given according to the physician's instructions per the Medication Administration Record (MAR). The new cycle of medications and MARs have been received and logged. The facility was observed to have a 2 day supply of perishable and a 7 day supply of nonperishable food items.

The facility was observed to have operable utilities (gas, water, electricity).

An exit interview was conducted, and a copy of this report, was provided to the Licensee/Administrator, Manuel Vasquez.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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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