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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 06/24/2022
Date Signed: 06/24/2022 11:35:35 AM

Document Has Been Signed on 06/24/2022 11:35 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
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:
06/24/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Licensee- Manuel VasquezTIME COMPLETED:
11:40 AM
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On 6/24/22 Licensing Program Analyst (LPA) Janira Arreola made an unannounced visit at the facility for the purpose of conducting a health and safety check. LPA Arreola met with licensee Manuel Vasquez, and explained the purpose of the visit.

LPA conducted a tour of the facility's interior and exterior, the facility was clean and clutter free. LPA observed the facility's food supply which met the requirements of the 2 day supply of perishable and a 7 day supply of non-perishable food items. LPA observed the paper supply and observed sufficent supply. LPA observed the facility's PPE supply and advised Licensee to acquire more to meet the 30 day supply requirement.

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

An exit interview was conducted where this report along with technical advisory note was reviewed and provided to Licensee Manuel Vasquez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2022
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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