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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 12/28/2023
Date Signed: 12/28/2023 05:21:12 PM

Document Has Been Signed on 12/28/2023 05:21 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 ASC, 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:
12/28/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Licensee Manuel Vazquez TIME COMPLETED:
01:55 PM
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On today's date 12/28/23, Licensing Program Analyst (LPA) Javina George made an unannounced visit at the facility for the purpose of conducting a health and safety check. LPA 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. Client #1 (C1) who is from the Sister facility (Casa Del Sol RTF #374603419) is not feeling well and stayed home from the day program today.

LPA conducted a tour of the facility's interior and exterior. The facility was observed to be clean and clutter free. The facility has (3) rooms that are vacant, and (1) room that is occupied.

LPA observed the facility's food supply which met the requirements; 2 day supply of perishable and a 7 day supply of non-perishable food items.

The medications for Client #2 (C2) are currently being stored at the Sister facility Casa Del Sol RTF #374603419. To accommodate staffing during the day. C2 will continue to go between the two facilities, spend the night at the Sister facility until the facility receives the health and safety waiver which would in turn increase the opportunity for additional staffing.

The facility's utilities such as electricity, gas and water were observed to be operable. There were no deficiencies observed during LPAs visit.

An exit interview was conducted, and a copy of this report was provided to Licensee, Manuel Vasquez.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2023
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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