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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 09/27/2022
Date Signed: 09/27/2022 01:08:27 PM

Document Has Been Signed on 09/27/2022 01:08 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:
09/27/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Manuel Vasquez - LicenseeTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Crystal Colvin, conducted an unannounced visit to the facility for the purpose of a health and safety check. LPA Colvin met with licensee Manuel Vasquez, who was informed of the purpose of the visit.

At the time of the visit neither of the two current residents were at the location, as one (R1) was at the dentist and the other (R2) was at the Licensee's second facility, where the Licensee had been until LPA Colvin contacted him to request entry into the facility. LPA Colvin 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 residents, PPE supplies, and food supplies. LPA observed that these were in sufficient numbers for the present number of residents. LPA Colvin confirmed all hazardous items were locked and inaccessible during LPA Colvin's inspection. No immediate health or safety concerns at this time.

An exit interview was conducted and a copy of this report was provided to Licensee/Administrator Manuel Vasquez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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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