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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 08/29/2024
Date Signed: 08/29/2024 10:30:57 AM

Document Has Been Signed on 08/29/2024 10:30 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
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:
08/29/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Manuel Vazquez, Licensee/Administrator TIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a health and safety check. LPA met with Licensee/Administrator, Manuel Vasquez and explained the purpose of the visit. The home continues to be open, and vacant due to no clients are currently placed at the home.

The facility is a single story four (4) bedroom, two (2) bathroom home. During today's health and safety check the facility was observed to have operable utilities (gas, water, electricity).

The facility continues to have supply of non perishable food items, as there are no clients in care. LPA discussed with Licensee Vazquez to be prepared to have a 2 day supply of perishable food items, as soon as he is made aware of any potential placement's.

Licensee Vazquez informed LPA that there repairs in process with the deck that is being repaired (painted, replacing nails), as well as the door knobs are being replaced in order to be HCBS complaint.

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

An exit interview was conducted and a copy of the report was provided to Licensee Manuel Vazquez.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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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