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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 04/07/2022
Date Signed: 04/07/2022 11:30:51 AM

Document Has Been Signed on 04/07/2022 11:30 AM - 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: 3DATE:
04/07/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Manuel Vasquez - Licensee/AdminitratorTIME COMPLETED:
11:45 AM
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On 4/7/22/22 Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of conducting a health and safety check. LPA Colvin was greeted and granted entry by Licensee Manuel Vasquez and informed him of the purpose of today's inspection. At the time of the visit there was (1) staff and two (2) residents present, as one resident is currently in the hospital.

LPA conducted a tour of the interior and exterior of the facility. The facility was clean and clutter free. LPA observed the facility to have the required of food, 2 day supply of perishable and a 7 day supply of non-perishable food items. The facility has an adequate supply of hygiene items and have the required covid postings. LPA Colvin was provided with a copy of the facility's staff schedule as well reviewed resident files to confirm plenty of staff present that the current ratio. LPA Colvin was additionally updated on which staff on the schedule (LIC500) are no longer working at the facility.

LPA Colvin observed all three residents present to be in no apparent acute distress, as they were either in their bedrooms or working on a puzzle in the common area. No health and safety concerns were observed.

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: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2022
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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