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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 01/12/2023
Date Signed: 01/12/2023 02:20:27 PM

Document Has Been Signed on 01/12/2023 02:20 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: 1DATE:
01/12/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Licensee and administrator, Manuel VasquezTIME COMPLETED:
02:35 PM
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On 1/12/2022 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 (1) staff and (1) client present. LPA conducted a tour of the facilities interior and exterior. The facility has (4) bedrooms and (2) bathrooms. The facility was observed to be clean and free of clutter. Client #1 (C1) was in the facility yard playing with a ball, and it was reported by licensee that Client #2 (C2) has been discharged from the facility. C2 is no longer a client of the facility effective date 1/12/2023. LPA obtained an updated resident roster for the facility.

LPA observed the facility's food supply which met the requirements; 7 day supply of non-perishable food items. 2 day perishable food items were observed to be low. Licensee stated they would be doing grocery shopping today. LPA observed a sufficient amount of PPE supplies at the facility. LPA observed clients medications and observed at least a 30 day supply. LPA observed a sufficient amount of paper supplies (paper towels and toilet paper), in the facility storage room.

No health and safety issues were observed during 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: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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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