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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600537
Report Date: 07/22/2024
Date Signed: 07/23/2024 01:29:14 PM


Document Has Been Signed on 07/23/2024 01:29 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:STANTCHEVA RESIDENTIAL CAREFACILITY NUMBER:
374600537
ADMINISTRATOR:NATALIA STANTCHEVAFACILITY TYPE:
735
ADDRESS:1509 HILLSDALE ROADTELEPHONE:
(619) 444-0863
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:4CENSUS: 4DATE:
07/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Natalia StantchevaTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Esther Kaleli. Licensee Natalia Stantcheva arrived shortly after.

According to the facility’s license, the facility serves four (4) developmentally disabled adults; ages 18-59 years old, all of whom must be ambulatory. During today’s inspection, the facility’s current census was 4.


LPA, accompanied by Licensee Natalia Stancheva and Caregiver Esther Kaleli, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. The rooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Personal Protective Equipment was available. The facility had sufficient space and equipment to facilitate programs, meetings, activities, and dining.

Water temperature at taps accessible to clients were compliant; the clients have one bathroom accessible to them, the temperature fat the bathroom tap was 119.3 F. The temperature at the kitchen tap was 112.5 F.

Cooking/dining equipment and utensils were present, and all safely stored. The facility had at least two days of perishable food and seven days of non-perishable food present. The facility had cooking and dining utensils to facilitate resident meal service. The facility’s ambient internal temperature was compliant at 74 F. There were no toxic chemicals/poisons accessible to clients. Medications were properly labeled, as required, and stored in locked areas.
[CONTINUED ON LIC 809-C]
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: STANTCHEVA RESIDENTIAL CARE
FACILITY NUMBER: 374600537
VISIT DATE: 07/22/2024
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[CONTINUED FROM LIC 809]
A pool was present on the premises and was surrounded with a fence and locked when not in use. Per Natalia Stantcheva, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present and serviced within the last 12 months. First aid kit(s) were complete and readily accessible.

LPA interviewed staff and reviewed staff and client records. Clients were at Day Program. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area.

There were no deficiencies observed or cited during today's annual inspection.

An exit interview was conducted Natalia Stanctcheva, to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
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