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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601655
Report Date: 01/31/2022
Date Signed: 02/01/2022 09:01:36 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SAN MARCOS COTTAGEFACILITY NUMBER:
374601655
ADMINISTRATOR:BILJANA RIBICHFACILITY TYPE:
740
ADDRESS:1326 GRANITE ROADTELEPHONE:
(760) 891-0328
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY:6CENSUS: 5DATE:
01/31/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Administrator Biljana RibichTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an announced Case Management visit, accompanied by Nurse, Robert Montillano, from the Healthcare Acquired Infection (HAI) team of San Diego County Health and Human Services Agency. LPA and HAI nurse were allowed entry into the facility, by Administrator, Biljana Ribich, after identifying themselves and stating the purpose of the visit. The team assessed the facility with the Administrator.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols, as well as the use of personal protective equipment (PPE). During today's visit, the Administrator was interviewed, and the team conducted a walk-though of the facility. A debriefing was conducted with the Administrator at the conclusion of the visit.

During today's visit, no deficiencies were cited. A copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to Administrator, Biljana Ribich, via electronic mail. An electronic receipt of confirmation was requested to be sent upon receipt of the documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
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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