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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 04/18/2024
Date Signed: 04/18/2024 11:45:13 AM


Document Has Been Signed on 04/18/2024 11:45 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
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:
04/18/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Manuel Vazquez, Licensee/AdministratorTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Javina George conducted a joint health and safety check with the placing agency, Service Coordinator Bianca Landgrave. At the time of the visit was one (1) staff and (0) resident's present as the residents were at the day program.

During today's health and safety check the facility was observed to have working utilities (gas, water, electricity). The medications are locked and inaccessible to the residents in care. The facility has a supply of hygiene products such as soap and shampoo for the residents to use.

An annual meeting was conducted on 4/17/24 and R1 will move to the Sister facility #374603419, effective 5/1/24. R1 will continue to go between the two facilities, including spend the night at the Sister facility. No update was given on the awaited health and safety waiver and it's approval.

LPA observed the facility's food supply to meet the minimum requirements of a 2 day supply of perishable and a 7 day supply of non-perishable food items.

There were no health and safety concerns observed during today's visit.

An exit interview was conducted and a copy of this report was provided to Manuel Vazquez, Licensee/Administrator.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 217-3970
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
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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