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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 05/04/2022
Date Signed: 05/04/2022 03:54:04 PM

Document Has Been Signed on 05/04/2022 03:54 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
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:
05/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:08 PM
MET WITH:Manuel Vazquez, AdministratorTIME COMPLETED:
04:05 PM
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On 5/4/22 Licensing Program Analyst (LPA) Javina George made an unannounced visit at the facility for the purpose of conducting a health and safety check. LPA George met with Licensee/Administrator Manuel Vazquez, and explained the purpose of the visit.

At the time of the visit there was (1) staff and (2) clients present. 1 client remains in the hospital.

LPA observed the facility to be clean, with freshly mopped floors, and a load of laundry going. Dinner was being prepared. LPA observed the facility to have the required amount of food, 2 day supply of perishable and a 7 day supply of non-perishable food items. The facility has ample supply of paper goods (toilet paper and paper towels).

LPA observed the facility to be within the required ratio of 3:1. LPA conducted a tour of the interior of the exterior of the facility. LPA greeted both clients (2) whom were outside in the backyard.

LPA did not observe any physical signs of distress. No concerns were brought to LPAs attention during the visit. Additionally, 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 Licensee/Administrator Manuel Vasquez.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2022
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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