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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 07/01/2022
Date Signed: 07/01/2022 12:07:14 PM

Document Has Been Signed on 07/01/2022 12:07 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:
07/01/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Licensee- Manuel VazquezTIME COMPLETED:
12:15 PM
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On 7/1/22 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 Vazquez 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 facilities interior and exterior. LPA walked through back yard, garage, kitchen, living room, dining room, and clients bedrooms. The facility has (4) bedrooms and (2) bathrooms. The facility was observed to be clean and free of clutter. C1 was observed resting in his room, and C2 was observed sitting on the porch.

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. LPA observed a sufficient amount of PPE supplies at the facility. LPA observed clients medications and observed at least a 30 day supply. LPA observed a sufficient amount of paper supplies (paper towels and toilet paper).

No citations were issued, and no health and safety concerns were observed at the time of the visit. Technical Advisory note was reviewed and provide to Licensee. An exit interview was conducted, and a copy of this report was provided to licensee Manuel Vazquez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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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