<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 04/18/2024
Date Signed: 04/18/2024 11:44:43 AM

Document Has Been Signed on 04/18/2024 11:44 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:
04/18/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:48 AM
MET WITH:Manuel Vazquez, Licensee/Administrator TIME VISIT/
INSPECTION COMPLETED:
10:07 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Javina George conducted a joint health and safety check with the placing agency, Service Coordinator Bianca Landgrave. 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 to have expired food, consisting of (3) loaves of bread, 2 bags of shredded cheese, bottle of sweet and sour sauce, and (3) bags of frozen meals. The items were discarded during LPAs visit. However due to this being a repeat observation with the last incident occurring on 2/28/24. Deficiency cited.

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.

Regarding the observations made in the resident bathroom during the visit conducted on 3/29/24. LPA observed for the linoleum that was lifting around the toilet seat to be taped to the ground. Per Administrator Manuel he will be trying a glue instead of tape. LPA observed for the paint on the cabinet inside the bathroom to be intact as it was taped down with clear tape preventing residents from being able to pick at the paint. LPA conducted a review of the facility personnel roster, as there have been some staffing changes.
The following was discussed during today's visit with the Administrator:
-Associating S1 to the facility by 5pm today 4/18/24
-Cleaning the window sills to remove the dust and cobwebs that were observed
-Having a copy of the program design available at the facility to review
-Follow up regarding medications that are needed for the residents at the day program
-Enroll in an upcoming Home and Community Based Services (HCBS) Final Rule training
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 04/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on today's health and safety check a citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 6).

An exit interview was conducted, and a copy of this report, 809D, appeal rights, LIC9098 Proof of Corrections form was provided to the Licensee/Administrator, Manuel Vasquez.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/18/2024 11:44 AM - It Cannot Be Edited


Created By: Javina George On 04/18/2024 at 11:01 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CASA DEL SOL RTF
FACILITY NUMBER: 374603419

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/02/2024
Section Cited
CCR
80076(a)(1)

1
2
3
4
5
6
7
80076 Food Service (a) In facilities providing meals to clients, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients... All food shall be selected, stored, prepared and served in a safe and healthful manner.
1
2
3
4
5
6
7
The licensee agrees to discard the expired items and to conduct an inservice on the risks of consuming expired food. Proof of correction is to be submitted to the department by 5pm on the due date indicated (5/2/24).
8
9
10
11
12
13
14
This requirement is not met as evidenced by: The licensee did not ensure that mutiple food items were discarded once expired. This poses a potential health, safety, and personal rights risk to person's in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tricia Danielson
LICENSING EVALUATOR NAME:Javina George
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3