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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602155
Report Date: 05/10/2022
Date Signed: 05/10/2022 12:04:32 PM


Document Has Been Signed on 05/10/2022 12:04 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 MANORFACILITY NUMBER:
374602155
ADMINISTRATOR:LOLITA V. GATMAITANFACILITY TYPE:
740
ADDRESS:1719 MEDINAHTELEPHONE:
(760) 798-1588
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY:5CENSUS: 3DATE:
05/10/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Lolita Gatmaitan LicenseeTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Chinwe Nwogene and Licensing Program Manager (LPM) Deborah Mullen arrived unannounced to the facility. LPA and LPM met with Licensee and explained the purpose of the visit. A Health and Safety inspection was conducted.

LPA observed three (3) residents in care at the time of visit. LPA observed all utilities to be on and operating without issue. There was a sufficient amount of staff present at the facility to provide care to residents. LPA assessed the available food supply and observed the supply to met the required two (2) day supply of perishable foods and a seven (7) day supply of non-perishable foods. Medications were observed to be locked and inaccessible to residents as appropriate.

Based on the information obtained during today's visit, no immediate health or safety concerns were observed and no deficiencies were cited during the visit.

An exit interview was conducted and a copy of this report was reviewed with and provided to Lolita Gatmaitan.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022
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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