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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601155
Report Date: 03/08/2024
Date Signed: 03/08/2024 02:09:05 PM


Document Has Been Signed on 03/08/2024 02:09 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:TWIN OAKS GARDEN IIFACILITY NUMBER:
374601155
ADMINISTRATOR:SNEZANA LUKICFACILITY TYPE:
740
ADDRESS:1961 EDWIN LANETELEPHONE:
(760) 471-8704
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY:6CENSUS: 5DATE:
03/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:29 PM
MET WITH:ADMINISTRATOR, LUKIC SNEZANATIME COMPLETED:
02:18 PM
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On March 08, 2024, Licensing Program Analyst (LPA), Venus Mixson conducted an unannounced annual required visit and met with Snezana Lukic, the Administrator, who was informed of the purpose of the visit. The Facility File review was conducted in the Regional Office and additional forms were requested and reviewed on site.

LPA Mixson toured the facility, along with the Administrator, Snezana Lukic and inspected the inside and outside of the facility. The facility is licensed for six but is currently operating at five, and is located at 1961 Edwin Lane San Marcos, CA. 92069, and the facility phone number is (760) 471-8704, and is operable.

Infection Control: The LPA observed restrooms and the kitchen, and each was equipped with liquid soap and paper towels for hand washing. LPA Mixson observed gloves and cleaning supplies to do regular cleaning of the facility. The LPA reviewed the facility's infection control plan and found all required infection control measures. LPA Mixson observed additional hygiene supplies at the facility. The LPA reviewed infection control training conducted with facility staff which met the department requirements.

Physical Plant/Planned activities: LPA Mixson observed the resident bedrooms each was equipped with required furniture as per regulations. Fixtures and furniture were in good repair and were present. The outdoor area was observed to be free of hazards. The laundry room was observed to be locked. The hot water temperature was recorded and logged within regulations.

Food Service: LPA Mixson observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. The LPA observed the facility met the required two day supply of perishable and seven day supply of non-perishable foods. Care & Supervision: five staff and five residents which is adequate per facility type and within the regulations.

Records Review: LPA Mixson reviewed staff and resident files, conducted staff and residents interviews, and reviewed Previous Community Care Licensing forms. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted, and a copy of this report was provided to the Administrator, Lukic Snezana.

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2024
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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