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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 11/29/2022
Date Signed: 11/29/2022 03:22:39 PM

Document Has Been Signed on 11/29/2022 03:22 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:
11/29/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:57 PM
MET WITH:Licensee/ Administrator Manuel VasquezTIME COMPLETED:
03:30 PM
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On 11/29/2022 at 02:57 p.m. 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.

At the time of the visit there was (2) staff and (2) client present. LPA conducted a tour of the facilities interior and exterior. LPA walked through back yard, kitchen, living room, activity room, and clients bedrooms and bathrooms. The facility has (4) bedrooms and (2) bathrooms. The facility was observed to be clean and free of clutter. Client #1 (C1) was outside on the patio, Client #2 (C2) was isolating in their room as he had a potential exposure to COVID-19. Licensee was in the process of doing an at home test on the resident during the visit. LPA advised licensee to report the positive if C2 tests positive. (2) rooms are vacant, and (2) rooms are occupied.

LPA observed the facility's food supply which met the 2-day perishable and 7-day non-perishable food supply. LPA observed a sufficient amount of PPE supplies at the facility. LPA observed clients medications and observed at least a 30 day supply, with new month cycle on hand. LPA observed a sufficient amount of paper supplies (paper towels and toilet paper) in the facility storage area.

No health and safety issues were noted at the time of the visit.

An exit interview was conducted, and a copy of this report was provided to Licensee, Manuel Vasquez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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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