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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602565
Report Date: 11/14/2024
Date Signed: 11/14/2024 11:13:35 AM

Document Has Been Signed on 11/14/2024 11:13 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:AVOCADO CREEKFACILITY NUMBER:
374602565
ADMINISTRATOR/
DIRECTOR:		MARIJA BANOVICFACILITY TYPE:
740
ADDRESS:1080 AVOCADO AVETELEPHONE:
(760) 822-5860
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
11/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Licensee, Marija BanovicTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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n 11/14/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to conduct a required annual inspection. LPA was greeted and granted entry by Caregiver, Marisa Hipolito who was informed of the purpose of the visit. Licensee, Marija Banovic arrived during the visit. The facility has a fire clearance for 12 non-ambulatory elderly residents of which one (1) may be bedridden. The facility also has an approved hospice waiver for five (5) and LPA was informed three (3) residents are currently receiving hospice services at the facility. During the visit, there was eight (8) residents and two (2) staff present.

LPA toured the facility with Caregiver Hipolito and observed the facility is made up of a one-story home with 10 resident bedrooms, seven 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. Indoor and outdoor passageways were free of obstruction. The facility had a two-day supply of perishable foods and seven-day supply of non-perishable foods, which were stored in a safe and healthful manner. Knives are secured in a locked kitchen drawer. Medications are secured in a locked dining room 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 Banovic tested one of the smoke alarms/carbon monoxide detectors and LPA observed it to be operation. LPA also observed charged fire extinguishers mounted throughout the facility, last serviced on 6/26/2024. Staff present have a criminal record clearance and valid first aid/cardiopulmonary certification. LPA reviewed the facility's Fire Drill Log noting the facility's last fire drill was conducted on 10/13/2024. Complaint information, facility sketch, and emergency phone numbers are visibly posted near the front entrance and dining room walls.

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 Banovic.
Tricia DanielsonTELEPHONE: (951) 202-5067
Janette RomeroTELEPHONE: (951) 529-2930
DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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