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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602571
Report Date: 12/28/2023
Date Signed: 12/28/2023 11:07:33 AM


Document Has Been Signed on 12/28/2023 11:07 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:OAK RANCH HOUSEFACILITY NUMBER:
374602571
ADMINISTRATOR:STANOYLOVIC, MARIJAFACILITY TYPE:
740
ADDRESS:10449 OAK RANCH PLACETELEPHONE:
(760) 297-1091
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:6CENSUS: 3DATE:
12/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:ADMINISTRATOR, MARIA STANOYLOVICTIME COMPLETED:
11:11 AM
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On December 28, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the required annual inspection and met with Administrator, Marija S. LPA Mixson introduced herself and stated the purpose of the visit. The facility file review was conducted at the office and on site.

LPA Mixson toured the facility along with the Administrator, and observed the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single-story home, located at 10449 Oak Ranch Place Escondido, CA 92026. Physical Plant: The facility phone number is (760) 297-1091 and is operable. The LPA observed the residents bedrooms, they were equipped with required furniture as per Title 22 at the time of this visit. LPA Mixson inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean and appliances were operating appropriately currently. The facility is equipped with smoke detectors, carbon monoxide alarms, and fire extinguishers, and they are operable. LPA Mixson observed required postings such as (If you See Something, Say Something), the (Ombudsman Poster), and the (Personal Rights). The cleaning supplies and sharp items were kept locked and inaccessible to the residents. There is a designated storage space for the resident and staff files and it was locked and inaccessible to residents. Medications: were reviewed, locked and inaccessible to residents in care. There was a 30 day supply of medication for each resident. The overall facility is clean, the furniture is in good condition. The facility air conditioning and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils are in sufficient supply and stored properly. Care & Supervision Facility has sufficient staff, currently at the time of this visit there are two staff, and three residents. Records Review: LPA Mixson reviewed three resident files, two staff files, interviewed two staff, and reviewed previous CCL forms. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted and a copy of this report was given to the Administrator, Maria Stanoylovic.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2023
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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