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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 07/14/2022
Date Signed: 07/14/2022 12:03:46 PM

Document Has Been Signed on 07/14/2022 12:03 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:
07/14/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Licensee-Manuel VazquezTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Janira Arreola made an unannounced visit to the facility for the purpose of a health and safety check. LPA was greeted and granted entry by licensee, Manuel Vazquez, who was informed of the purpose the visit.

At the time of the visit there was one staff member present. LPA observed the facility to be within the required ratio of 3:1. LPA toured the interior and exterior of the facility. LPA observed the clients medication in locked medication cabinet to be within the 30 day supply. Licensee informed LPA that C1 and C2 were at their day program. LPA observed the kitchen for the required 2-day perishable and 7-day non-perishable foods. LPA observed that this requirement was met. LPA observed the restrooms and client rooms. There are currently (2) rooms that are vacant and (2) rooms that are occupied. LPA observed facility restroom to have toilet paper and the necessary hygiene supplies. LPA observed the facilities paper supply, and 30-day PPE supply.

There were no health and safety issue observed during the time of the visit.

No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided to licensee, Manuel Vazquez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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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