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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602565
Report Date: 11/29/2023
Date Signed: 11/29/2023 11:21:15 AM


Document Has Been Signed on 11/29/2023 11:21 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:AVOCADO CREEKFACILITY NUMBER:
374602565
ADMINISTRATOR:MARIJA BANOVICFACILITY TYPE:
740
ADDRESS:1080 AVOCADO AVETELEPHONE:
(760) 822-5860
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:12CENSUS: 9DATE:
11/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:ADMINISTRATOR, MARIJA BANOVICTIME COMPLETED:
11:30 AM
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On November 29, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection, and met with the Administrator, Marija Banovic.

LPA Mixson toured the facility, along with the Administrator, Marija Banovic, and inspected the inside and outside of the facility. There were no obstructions to indoor and/or outdoor passageways at the time of this visit. The facility is a single story home, located at 1080 Avocado Ave Escondido CA 92026.

Physical Plant: The facility is not operating in the capacity approved by Community Care Licensing (CCL), which is 12, but has 9 residents at the time of this visit. The facility phone number is (760)822-5860, and is operable at this time. The LPA observed the resident's bedrooms, and each was equipped with required furniture; including bed & mattresses, night stands, storage space, and sufficient lighting. The LPA inspected the residents bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean and appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and a fire extinguisher. Posters such as; the Ombudsman and CCL complaint poster were posted in a common area. The cleaning supplies, toxins, and sharps were kept inaccessible to residents in care. There was a designated storage space for resident and staff files. Medications: were reviewed, and were locked and inaccessible to the residents. The overall facility is clean, in good repair, and operating in safe conditions for residents currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient for number of residents, and there are a variety of food types available for the residents. Dishes and utensils were also stored properly. Care & Supervision: Facility has sufficient staff, and staff were engaging the residents during this visit. Record Review: LPA Mixson interviewed two staff, the residents were not available at the time of this visit. The LPA reviewed four resident files, and two staff files, and the required CCL reports from previous visits. There were no observable Title 22, Division 6 Regulation violations observed and/or cited during todays visit.
An exit interview was conducted and a copy of this report was given to the Administrator, Marija Bancovic.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
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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