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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 06/21/2023
Date Signed: 06/21/2023 07:25:15 PM

Document Has Been Signed on 06/21/2023 07:25 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
RIVERSIDE AC/SC, 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:
06/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
05:35 PM
MET WITH:Manuel Vasquez, LicenseeTIME COMPLETED:
07:30 PM
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility to conduct an annual inspection. LPA was met by Licensee, Manuel Vasquez and explained the purpose of the visit. Present in the facility during time of visit were one (1) resident and no additional staff were present. Licensee stated current census is one (1) client.

The facility is a one story four (4) bedroom, two (2) bathroom home. The facility appears clean and free of odors. Resident bedrooms are clean and appropriately furnished. All smoke and carbon monoxide detectors were tested and found operable. Fire extinguishers are current. Food supplies are sufficient including a two (2) - day supply of perishable and a seven (7) - day supply of non-perishable food items. LPA observed a sufficient amount of personal protective equipment (PPE) supplies at the facility. Emergency food and water was stored in the garage area. Hot water was measured at 123.4 degrees Fahrenheit within appropriate range. LPA observed all toxic chemicals and other hazards secured and inaccessible to residents and are centrally stored in a locked cabinet in the converted garage. Furniture in the facility is in good repair. Outdoor space is free of hazards.

LPA inspected staff and client records. Review of staff records indicated all staff have criminal record clearances and are appropriately associated to the facility. Staff files had the required documentation including First Aid Certifications and training documents. P&I monies are kept in a locked safe and are kept separate from facility funds. LPA inspected medications and medications appear to be dispensed appropriately according to physician's orders. The facility is completing emergency drills on a quarterly basis.
During the inspection, no deficiencies were observed. An exit interview was conducted and a copy of the report and LIC 811 was provided to Licensee.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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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