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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 06/09/2022
Date Signed: 06/09/2022 04:38:17 PM

Document Has Been Signed on 06/09/2022 04:38 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:CASA DEL SOL RTF IIFACILITY NUMBER:
374604100
ADMINISTRATOR:VASQUEZ, MANUELFACILITY TYPE:
735
ADDRESS:1141 JULIETTE PLTELEPHONE:
(760) 645-3195
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 4CENSUS: 2DATE:
06/09/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
04:24 PM
MET WITH:Jaciel Ordaz, DSP TIME COMPLETED:
04:50 PM
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On 6/9/22 Licensing Program Analyst (LPA) Javina George made an unannounced visit at the facility for the purpose of conducting a health and safety check. LPA George met with Jaciel Ordaz, DSP, and explained the purpose of the visit.

At the time of the visit there was (1) staff and (2) clients present. LPA observed the facility to be within the required ratio of 3:1. LPA conducted a tour of the facility, the facility was clean and clutter free. All clients were inside 1 was eating dinner and 1 was doing an activity in the sensory room.

LPA observed the facility's food supply which met the requirements; 2 day supply of perishable and a 7 day supply of non-perishable food items.

No citations were issued health and safety concerns were observed during the visit,

An exit interview was conducted, and a copy of this report was provided to Jaciel Ordaz, DSP.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2022
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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