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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601655
Report Date: 01/14/2025
Date Signed: 01/14/2025 11:38:46 AM

Document Has Been Signed on 01/14/2025 11:38 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SAN MARCOS COTTAGEFACILITY NUMBER:
374601655
ADMINISTRATOR/
DIRECTOR:		BILJANA RIBICHFACILITY TYPE:
740
ADDRESS:1326 GRANITE ROADTELEPHONE:
(760) 891-0328
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Licensee, Biljana Ribich TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 1/14/2025, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to conduct a required annual inspection. LPA was greeted and granted entry by Licensee, Biljana Ribich who was informed of the purpose of the visit.

LPA toured the facility with Licensee and observed the facility is made up of a one-story home with six (6) resident bedrooms, two (2) resident bathrooms, a kitchen, dining room, and attached garage. Resident bedrooms had the required bedding, furniture, and lighting. Bathrooms had grab bars and non-skid mats in the showers. The facility has an in-ground pool in the backyard that is secured with a locked fence. Indoor and outdoor passageways were free of obstruction. The facility has more than two-day supply of perishable foods and seven-day supply of non-perishable foods, which are stored in a safe and healthful manner. Medications are secured in a locked kitchen cabinet. LPA toured the garage and observed an operating laundry washer and dryer along with additional incontinent supplies, blankets, comforters, food and water. Cleaning solutions are secured in a locked storage cabinet in the garage. Licensee tested one of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed charged fire extinguishers mounted throughout the facility, last serviced on 11/6/2024. The facility's certificate of liability insurance expires on 10/31/2025. Staff present have a criminal record clearance. Resident files reviewed had updated physician's reports and signed admission agreements. The facility's last fire drill was conducted on 10/16/2024. Complaint information, facility sketch, and emergency phone numbers are visibly posted near the front entrance.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee.
Tricia DanielsonTELEPHONE: (951) 202-5067
Janette RomeroTELEPHONE: (951) 529-2930
DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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