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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 12/05/2022
Date Signed: 12/05/2022 07:29:10 PM

Document Has Been Signed on 12/05/2022 07:29 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:
12/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:50 PM
MET WITH:Manuel Vasquez, Licensee/AdministratorTIME COMPLETED:
05:05 PM
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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conduct a case management visit in conjunction with complaint 18-AS-20220330124618 to check on the health, safety, and welfare of clients in care. LPA met with Licensee/Administrator Manuel Vasquez and explained the purpose of the visit.
One(1) client was present during visit. There was one(1) staff present at the facility to provide care. LPA toured the facility during today's visit. LPA observed all facility utilities to be on and operating without issue. LPA assessed the available food supply and observed that the supply exceeds the requirement of a two(2) day supply of perishable foods and a seven(7) day supply of non-perishable foods. Medications were found to be in sufficient supply as well. The facility was free from obstructions and/or hazards.
Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the clients in care.

Also during today's visit, LPA served Vasquez with an immediate exclusion letter for staff Fernando Perez. LPA informed Vasquez that the Department has determined that the presence of Fernando Perez in a facility licensed by the Department of Social Services constitutes a threat to the safety to residents in care, the Department therefore orders the facility to remove Fernando Perez. LPA did not observed Perez at the facility during today's visit. Vasquez reported Perez was terminated November 18, 2022. LPA informed Vasquez that Mr. Perez had been excluded from being employed in any facility licensed by the Department of Social Services and was not permitted to return to the facility. Vasquez stated he understood the conditions of Fernando Perez's exclusion and would not permit Perez to return to the facility.



An exit interview was conducted and a copy of this report was provided to Vasquez.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2022
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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