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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 05/01/2024
Date Signed: 05/01/2024 12:22:07 PM

Document Has Been Signed on 05/01/2024 12:22 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/
DIRECTOR:		VASQUEZ, MANUELFACILITY TYPE:
735
ADDRESS:1141 JULIETTE PLTELEPHONE:
(760) 645-3195
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 4CENSUS: 0DATE:
05/01/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Mnauel Vazquez, Licensee/Administrator TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Javina George conducted a health and safety check. 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.

As of 4/18/24 the facility was granted the Health and Safety Waiver, which allows for the facility to offer competitive wages in hopes of retaining sufficient staffing. Today 5/1/24, R1 will move to the Sister facility #374603419 as discussed during the quarterly meeting that was held 4/17/24.

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.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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