374603419-5-1-2024-18-AS-JGEE-D4URKA-20240501130513

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603419
Report Date: 05/01/2024
Date Signed: 05/01/2024 01:05:18 PM

Document Has Been Signed on 05/01/2024 01:05 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: 3	DATE:	05/01/2024
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Manuel Vazquez, Licensee/Administrator		TIME VISIT/ INSPECTION COMPLETED:	10:45 AM

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On 5/1/24 Licensing Program Analyst (LPA) Javina George conducted a case management deficiencies visit. LPA met with Licensee Manuel Vazquez and explained the purpose of the visit. A complaint was received for the facility and additional concerns/allegations were reported. It was alleged that Administrator Manuel Vazquez was unfit to do his job. As Vazquez was reported to purchase cheap cleaners purchased at the Dollar store and would refill/use the same bottles and refill them with either water or some other fragrance/floor cleaner to mask that he is complying with disinfectants during this pandemic, not conducting fire drills and clients would buy their own hygiene items.

It was also alleged that the clients were buying their own hygiene items, as the Licensee/Administrator stopped purchasing the hygiene items.Per the client’s admissions agreement it states that the licensee is to provide hygiene items such as toothbrushes, razors, shampoo etc. Per an interview with Vazquez, the hygiene items provided were generic and if for example a client had dandruff and required a special shampoo outside of what was provided then the client would use their P& I to purchase the specialty item.

Regarding the cleaner’s interviews were conducted with staff and revealed that things had gotten there were arguments over the types/brands of chemicals that were purchased. Vazquez denied refilling the bottles with water and using fragrances to imply that the cleaners were able to clean and disinfect as expected during the pandemic. On 12/28/23 LPA conducted a facility visit and observed for the cleaners to consist of bleach, a degreaser, cleanser and an all-purpose cleaner. The cleaners observed were EPA approved cleaners, that are noted to clean as well as disinfect. There was not enough evidence to refute or corroborate the allegation.

It was also alleged that the Administrator was not at the facility a sufficient number of hours. Per an interview with Vazquez he states that he was at the facility for a minimum of 2-3 hours daily 6 days a week, and that in his absence there were two (2) designated staff leads that were required to report the status of the facility at the end of the shift. Vazquez stated that outside of the the hours he would accompany clients to

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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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: 05/01/2024

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appointments, complete shopping and complete any necessary repairs. Per staff interviews Vazquez was present at the facility however the exact times could not be recollected. LPA conducted a review of staff schedules which revealed that Vazquez would be at the facility daily. Further LPA reviewed Client Daily Reports where the staff have to provide their initials to verify that they are the ones inputting the data and or observations made. LPA observed for the licensee's initials to be present on logs reviewed for Aprl, May, June 2020. LPA also conducted a records review of staff schedule and observed for the Vazquez to be also be scheduled There was not sufficient evidence to refute or corroborate the allegation.

Regarding the fire drills it was alleged that fire drills were not being conducted, and that the Administrator fills out the forms//logs himself. Per an interview with the Administrator this too did occur as Mr. Vazquez stated that he would conduct the drills without the staff participating but would see him conducting the drills with the clients, and he would fill out the form/logs. Based on self admission the allegation is substantiated.

Based on the self-admission of the drills not being conducted as required with staff participation a deficiency is being issued a 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 and LIC9098-proof of corrections form was reviewed and provided to Manuel Vazquez.

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

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/01/2024 01:05 PM - It Cannot Be Edited

Created By: Javina George On 05/01/2024 at 11:23 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: 05/01/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/01/2024 Section Cited HSC 1569.695	1 2 3 4 5 6 7	(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter.... While facility may provide an opportunity for residents to participate it shall not require resident participation. Documentation of the drills	1 2 3 4 5 6 7	The licensee agrees to conduct an emergency disaster drill with as required with staff participation. POC is to be submitted to the department by 5pm on the due date indicated.
	8 9 10 11 12 13 14	shall include the date, type of emergency covered by the drill, & names of staff participating in the drill. This requirement is not met as evidenced by: licensee did not have staff participate in drills which posed an immediate health, safety and personal rights risk to persons 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: 05/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024

LIC809 (FAS) - (06/04)

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