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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 08/10/2022
Date Signed: 08/10/2022 11:28:31 AM

Document Has Been Signed on 08/10/2022 11:28 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:
08/10/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:59 AM
MET WITH:Licensee- Manuel VasquezTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility for the purpose of a health check. LPA met with Licensee, Manuel Vasquez, who was informed of the purpose of the visit.

At the time of the visit there were (0) clients and (1) staff present. LPA observed the facility to be within the required ratio of 3 to 1. LPA conducted a tour of the interior and exterior of the facility. LPA checked the facilities paper supply, medication supply for clients, PPE supplies, and food supplies.

LPA observed C1 and C2 were not at the home at the time of the visit. Licensee informed LPA that C1 and C2 were at their respective day programs. LPA looked into client bedrooms and bathroom.

There were no deficiencies cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided to Licensee, Manuel Vasquez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
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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