374603419-12-11-2024-18-AS-JARA-DBV3LC-20241211172030

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 12/11/2024
Date Signed: 12/11/2024 05:21:18 PM

Document Has Been Signed on 12/11/2024 05:21 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 RTF		FACILITY NUMBER:	374603419
ADMINISTRATOR/ DIRECTOR:	MANUEL VASQUEZ		FACILITY TYPE:	735
ADDRESS:	1561 E MISSION RD		TELEPHONE:	(442) 444-8156
CITY:	FALLBROOK	STATE: CA	ZIP CODE:	92028
CAPACITY: 4		CENSUS: 2	DATE:	12/11/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:00 PM
MET WITH:	Licensee, Manuel Vasquez		TIME VISIT/ INSPECTION COMPLETED:	05:25 PM

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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Licensee, Manuel Vasquez who was informed of the purpose of the visit. At the time of the visit there was (1) staff and (2) clients present.

The facility is a one story home with (4) bedrooms and (2) bathrooms. No pools or firearms are being kept at the facility. The facility is an adult residential facility. LPA conducted interviews, walk through, and records review.

Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements.

Physical Plant: Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients in pantry closet. The smoke detector and carbon monoxide was operational, and the hot water temperature 108.8F.

Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 RTF	FACILITY NUMBER: 374603419
	VISIT DATE: 12/11/2024

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Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. LPA also reviewed the staff scheduled showing adequate staff coverage. Required postings were found in the facility. The listed administrator has proof of submitting a renewal for the administrator certificate to the department.

Record Review and Resident/Staff Files: LPA reviewed (4) staff files and training. (1) on call staff did not have a first aide and CPR certificate. LPA checked the staff schedule for the past month and found the staff has not worked at the facility. Technical note was documented for licensee to send the staff's CPR by 12/13/2024. (2) client files were reviewed, and possessed all required paperwork. All personal and incidental funds were checked and verified during the visit.

Health Related Services/ Incidental Medical Services: All client medication was locked in closet. LPA reviewed client medications for (2) client and found all medication listed on MARS and accounted for.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last fire drill 11/7/2024, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the and first aid kit with all required items.

No deficiencies were cited at the time of the visit. An exit interview where this report was reviewed and provided.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

LIC809 (FAS) - (06/04)

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