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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604100
Report Date: 05/12/2022
Date Signed: 05/12/2022 05:22:41 PM

Document Has Been Signed on 05/12/2022 05:22 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
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: 2DATE:
05/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:41 PM
MET WITH:Manuel Vazquez, AdministratorTIME COMPLETED:
05:30 PM
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On 5/12/22 Licensing Program Analyst (LPA) Javina George made an unannounced visit to 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 (2) staff and (2) clients present. As of 5/7/22, the facility's census has changed due to the client that had been in the hospital was discharged from the home, as there was a change in their ambulatory status. LPA observed the facility to be within the required ratio of 3:1.

LPA observed 1 client eating dinner, and 1 other client was giving LPA a tour of their room. The facility was observed to have met the food requirements, by having a 2 day supply of perishable and a 7 day supply of non-perishable food items.

There were no health and safety concerns observed, therefore no citations were issued 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: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2022
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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